recovering from stomach flu

[bethann]

My 12 yr old son (who has a mech aortic valve) had an unusual week. Earlier this week he got his braces on (mega dose of amoxicillin) and then it was hard to eat for a couple of days, so his vitamin K was a unusually low. He recovered and ate fairly well thursday and friday, and yesterday was down all day with a stomach bug. No food, vomiting, diarrhea...basically dehydrated. He did keep his warfarin down yesterday though.

I was worried about his inr with all this and we tested this morning. He's at 5.2 - I wasn't surprised. His range is 2.0-3.0 and he's usually really steady, unless there is an event like this.

He has lightening fast metabolism and alternates 9 and 10 mg warfarin. The nurse wants me to skip his dose today and give him 5 tomorrow and then back to normal. From experience, it seems that the warfarin goes through his system much faster than most - I'd say 1 1/2 - 2 days. I think that response could bring him down too fast.

He's drinking well today and even eating a bit. So, assuming his metabolism starts to get back to it's old self today - 2 days from now he could have very little warfarin left in his system.

Ahh...the art of managing warfarin....

I would appreciate any thoughts or advice.


Thanks, Bethann

 

[catwoman]

Bethann:

The algorithm dosing chart I use says that people on more than 6mg of warfarin a day will drop more rapidly if a dose is held than those who take less than that, which is understandable.

Rather than holding a dose, some people would halve the dose for 1-2 days, then go back to normal. And then retest after about 3-4 days.

That's what I would do, but I've been adjusting my own dosage for about 6 of the 7 years I've been home-testing. I don't have to report my INRs to my PCP's office. My PCP keeps a copy of my algorithm chart in my file -- it's not the one his practice uses.

What you might want to do is to call the nurse again, and question the instructions, saying you think it could put your son's INR on a roller-coaster ride. And ask if it's possible to halve the dose. If you were the patient, it would be a different situation, but with a child as the patient, it's another story.

Your son's INR is the result of several things going on: not eating well because of the braces and then the stomach bug. However, the aftereffects of the stomach bug may continue to influence the INR for another 24-48 hours, since it may have hurt the health bacteria that reside in the gut and that produce a major portion of the vitamin K the body needs. Not all vitamin K comes from food or vitamin sources.

 

[bethann]

Thanks Marsha,

I did not know that about the 'healthy bacteria' and vitamin K. That is very useful info.

I talked to the nurse again. She wouldn't change the dose, but said she'd call the doctor on call and double check. I gave her all kinds of statistics on what we've done before and how he reacted. So hopefully they will understand the level of understanding we have of his situation (not just the average kid), and agree to some changes.

I will probably test him in the morning - not to change doses - but to see how much we have to restrict his activity. He is a very sports-loving, active kid. We don't typically restrict his recess play - so I may have to send him off with a 'no flag football' warning tomorrow.

 

[Philip B]

Dosing?

Dosing?

For what it's worth, even on those rare occasions when I swing out of my range on the high side, I don't ever hold a dose. Simply reducing my dosage brings me back into range with little fuss. Of course, I do my own management and don't run my results past a nurse or doctor.

Just curious... what's the point of consulting with nurses and/or doctors if you don't trust them?

-Philip

 

[Bina]

IF my own inr was at 5.2 then taking 1/2 dose would do the trick until my body readjusted...no holding.
Of course spinach salad and broccoli would be lunch and dinner