Need help! INR higher than 9.0

[Blanche]

Sure could use help with this one. Hope and pray that Al lodwick sees this soon.

Al has been having some problems with the runs since Monday. On Wednesday, he could not urnate. Thursday AM I took him to the uruologist who catheritized him and he now has a urine bag. He still has some blood in the urine bag, but not much.

This morning I insisted he do an INR test. First test had an error. The
second test was 7.5 or more. The INRatio maxes out at 7.5. Called our internist and went for a stat INR test, with a blood draw.

They just called. INR=more than 9.0. Doctor wants him to take 2.5 of vit. k twice a day and no Coumadin "Till further orders." He also wants a blood draw and INR test "Stat" on Monday morning.

It's Friday late afternoon. The emergency rooms are understaffed and will have a full house early evening. The emergency room doctors leave a great deal to be desired. And, I have yet to see one who knew about anticoagulation. The cardiologists are not much better, but week-ends are staffed by new doctors or physicians' assistants.

I don't know what to think.

Blanche

 

[ShezaGirlie]

Blanche......
I feel your anguish. For what it's worth -- my INR was over 8.0 (that's as high as a CoaguChek will read) so don't really know how high it was, but I simply halved my dose two nights and I was back in the saddle on the third day.

GOOD LUCK..!

 

[Karlynn]

Did the doc do other blood work? It sounds like something has changed his metabolism.

 

[Blanche]

Karlynn:

He's been having bad diarrhea, which would be enough to raise his INR a bunch. We tested 6 days ago and he was at 3.0, a little low for him.

The only "blood" test taken was the one for the INR at the doctors office today at Noon.

It is so difficult to know what to do now.

Blanche

 

[Ross]

One day of vitamin K should be plenty. He should do one day then test in 24 hours to see where it's at.

 

[Ross]

http://www.mja.com.au/public/issues/181_09_011104/bak10441_fm.html#CHDDCIFC

 

[Nancy]

Blanche-

I am concerned about the runs and also about his inability to urinate. I know he has a catheter in now and urine sems to be flowing, but I would want more information on why this happened. That doesn't seem related to the runs nor does it seem to be related to his INR being high.

If it were Joe, I would take him to the ER and have them decide what tests to run.

I guess what I am saying, is I am more concerned about his symptoms than anything else.

It sounds like something happened to block his urine excretion.

He should get seen fast in the ER, since he has a difficult medical history including stroke. Strokes can happen elsewhere than in the brain, Joe had a couple in his spleen.

I'll be thinking about you both. God bless.

 

[marie]

I can not comment on coumadin since I have zero experience with it but I wanted you to know I'll be thinking of you and praying as well.
Please keep us posted.
Earline

 

[Duff Man]

One day of vitamin K should be plenty. He should do one day then test in 24 hours to see where it's at.

Is this something you guys are prescribed when you're put on coumadin? How does one get vitamin k in a tablet form?

 

[Ross]

Is this something you guys are prescribed when you're put on coumadin? How does one get vitamin k in a tablet form?

Aaron it is used to radically reduce the effects of warfarin in a big hurry such as bleeding. Otherwise, plasma or whole blood will do the job also, just not as quickly. Also, getting the INR back up after using vit k to reverse it, is difficult and timewise, lengthy.

Only by prescription from the Doc can you get it in tablet form.

 

[Jackie]

Hi Blanche, Sorry to hear about Al, my prayers and best wishes being sent your way.

 

[Bina]

Blanche, I'm so sorry to hear that things have gone badly since Wednesday.
That was a very fast INR spike.....I hope that someone will see Al and find some answers.
Best wishes to you both.

 

[EVELYN]

Hi Blanche

So sorry to hear about Al. I will put you both in my prayers. I'm kind of in agreement with Nancy on this one. Knowing his history, I would certainly watch him very closely this weekend (which I know you will do) or get him to an ER if anything seems amiss.

Please keep us posted.

Evelyn

 

[hensylee]

Nancy is always wise.

I am so sorry to hear this about Al. Wishing him/you a quick solution to get him in the proper range. Thinking of you.

 

[Cooker]

Al ... All will be well ... listen to Blanche

 

[Bina]

Blanche, I hope Al is feeling a bit better today.
He is in my thoughts. (hugs)

 

[Karlynn]

I hope so too! I keep checking back here
for a report.

 

[marie]

Anyone hear from Blanche today?

 

[Blanche]

Many, many thanks

Many, many thanks

Dear friends:

Thank you for the support and concern. The information and advice that you provided helped us get through a very difficult day. Albert has read every post. Without your input and kindness I just don't know how we would have gotten by the worst part of this scare.

At this moment, Al is feeling much better. His doctor called last evening and we talked for a very long time. He advised that Al take 2.5 mg of vitamin K last evening and this morning. He also advised Al to discontinue Coumadin until Monday. He wants Al to test Monday with a blood draw (STAT) at his office.

Our doctor also felt that hospitalization was not necessary at this time. He did point out that we live less than 5 miles from the hospital and that we certainly could get there quickly later if needed. In any event, we would have had to go through the emergency room, and that is sheer torture on Friday evening. Also, the paramedics from the fire station are less than a mile from us. Their response is very swift and they certainly know the way to our house...

Albert took 2.5mg of vitamin K last night and again this morning. He did stop his Coumadin dose of 6.0. One of the charts in the article that our dear Ross sent has a box entitled "Guidelines for the management of an elevated international normalized ratio (INR) in adult patients with or without bleeding," indicates that the proper procedure is "to cease warfarin therapy, give 2.5 - 5.0mg vitamin K.....resume warfarin therapy at a reduced dose once INR is less than 5."

Albert's spirits are very high right now. We were up and down all last night but we slept a long time this afternoon. I took over all of his chores but he did make us scrambled eggs and cheese for brunch. After a very long nap, we both woke-up with a much better disposition and with positive feelings that he his now on the mend.

Many, many thanks to all of my vr.com friends who posted, called us, and sent pms and e-mail. We really could feel the prayers and well wishes.

Kindest regards,
Blanche

 

[Ross]

Let me know what his INR was once you check it.