Salmonella...not sure what to do.

[KristyW]

Hey all...this is rather indelicate I suppose, but I'm in a quandry. I contracted some salmonella (I'm supposing) from some lettuce that I didn't wash very well. As a consequence, I haven't been able to keep much inside for the last 2 days. I haven't had ANY vegetables or my vitamins since that makes the problem only worse.

My question is...what do I do with my warfarin dose? Do I keep going knowing that I'm not getting any vitamin k? Do I halve it?

BTW Here's my dose schedule. 7.5mg Su, Tu, Th, Sat. 5mg MWF.

Any suggestions?

 

[Emma]

Hiya,
Firstly, I sympathise cos I have the most awful tummy/sick bug today and cannot keep anything down either! (notice I still manage to get on my laptop though! lol).

Sorry, I digress. Do you test with coaguchek or another home test monitor? If so, I'd do a test now cos after 2 days of sickness I'd imagine your INR could be a 'little' high. Or can you go to a clinic for a test at short notice? I don't know what to suggest about your dosage without knowing what your INR is at present.
When was it last checked? Was the result ok then?

Hope you feel better soon and your INR isnt too affected by it

Love Emma
xxx

 

[KristyW]

I wish I had a home PT monitor, but my Ins Co (Kaiser Permanente) will not have anything to do with that right now. My PT was 2.8 3 weeks ago at my last test, I'm due to test this Thursday. The biggest problem is that it's ALWAYS a venous draw. I stay in range pretty well. Nothing very drastic. Sometimes a 4.5 but I can always figure out why it gets high, so my coumadin clinician and I agree on how to handle things. I'm just at a loss what to do right now.

 

[sylviayasgur]

hi kristy,
i'm so sorry that you are not feeling well. i'm sure this affects your inr...
although i am not that knowledgeable when it comes to anticoagulation, how about sending allodwick a PM? he would probably be very helpful here.
or else i'm sure someone who is familiar will come along soon enough.
feel better,
sylvia

 

[Emma]

Just to give you some idea of how the INR can be affected by sickness as Chloe has proved so well tonight...

Chloe had an INR of 4.0 on thursday, had a sicky bug on friday (but was only sick twice and not a lot) but still tested at 5.4 today so it does raise the INR.

Emma
xxx

 

[Karlynn]

What a yucky thing to have happen!

If you can't keep anything down - are you saying you aren't keeping your warfarin down either? I would get an INR test done before you do anything with your dose. If you aren't keeping the warfarin down, then your INR will be dropping. If you are getting some warfarin into your system, but not much else, it could be going up. So the best thing to do is get a test.

Good luck.

 

[KristyW]

Thanks all...I guess I'll just head to the lab tomorrow morning...fortunately I have the day off. However, my anticoag tech does tend to overreact at times to a high INR. I usually refuse to hold a dose when she tells me to. I'll halve it instead and tell her that's what I'm doing.

I am keeping stuff down now, but my diet is FAR from normal. Usually I have a good size (3-4 cups) salad made with spinach, romaine, cucumbers, edammame and a bunch of other stuff EVERY DAY for lunch...plus another dark green veggie for dinner, so that's what I'm really worried about.

 

[Ross]

I'm sure it will go up, but I don't think it will rise enough to cause concern. I'd say stay at the same dose and test as usual. Once this is past and things smooth out again, you should be fine. I think you can afford a small rise for a few days.

 

[Marty]

Thanks all...I guess I'll just head to the lab tomorrow morning...fortunately I have the day off. However, my anticoag tech does tend to overreact at times to a high INR. I usually refuse to hold a dose when she tells me to. I'll halve it instead and tell her that's what I'm doing.

I am keeping stuff down now, but my diet is FAR from normal. Usually I have a good size (3-4 cups) salad made with spinach, romaine, cucumbers, edammame and a bunch of other stuff EVERY DAY for lunch...plus another dark green veggie for dinner, so that's what I'm really worried about.

We usually treat patients with salmonella with FLAGYL (mitronidazole). Are you taking it by any chance? It can raise your INR. You probably should reduce your dose of warfarin while on flagyl like 10 to 15% and go back on your regular dose of warfarin after you quit taking flagyl or other antibiotics.

 

[KristyW]

Self Diagnosed

Self Diagnosed

Marty,

I actually don't have an official diagnosis, but I know this is a type of food poisioning. I just figured that it was salmonella from the symptoms. Actually this is what my mom calls "stomach flu". I'm not taking anything for it...just letting it run its course. I'm able to keep food in...so I'n not worried about dehydration or anything like that.

I am going in tomorrow to get my INR tested, so I'll know then what's going on.

Thanks everyone for your input.