How does diarrhea or vomiting affect someone's INR?

NurseLoveJoy88, ASN, RN · Jan 13, 2011

What information have you gathered so far from books and online sources? You may be able to find the information more efficiently by reading from either your own text sources or online. Good luck ! Let us know what you find.

leslie :-D · Jan 13, 2011

start by trying to understand the implications of hemoconcentration.

leslie

NewTexasRN · Jan 13, 2011

I might be totally wrong about this but here goes nothing. When a person have diarrhea and vomiting, they become dehydrated. This leads to hemoconcentration due to a decrease of fluids in the blood. The INR is used to measure how thin the blood is. If the blood is hemodiluted, then I am suspecting that this will help to lower the INR level, which means more clots. Therefore it would decrease.

Over-the-hill-Nurse · Jan 13, 2011

When thinking about someone having diarrhea and/or vomiting, you have to think about what it does to the body. Look at all of the assessment skills- mental status, vital signs, skin, urine output. If you have a change in mental status such as confusion, or vital signs such as body temperature, are they sweating, is the skin dry, moist, turgor is also important, heart rate, is it fast, slow or normal, blood pressure is it high, low or normal, respirations are they fast, slow or normal. With a fluid loss you can see a faster heartrate, lower blood pressure, and the temp could be elevated, normal or low depending on what stage of dehydration they are in. Sweating also can cause a loss of body fluid, especially if fever is present, the body uses a significant amount of water in the form of sweating to cool the body down. Heat and exercise can also play a large part in becoming dehydrated, through sweating, so it is not always visible. Urine output is another thing that you would look at- the amount, color, frequency. Urine will tend to be dark in color, with low amounts of output and a decrease frequency. You would also need to think about what could be other diagnosis such as diabetes, electrolyte imbalances, UTI's, etc on what is causing the diarrhea and vomiting. Other thing to look at is medications, what are they taking-prescribed and non prescribed. Tylenol is a big one of nonprescribed medicines that interact with coumadin if they are on blood thinners.

So when you think about the hemoconcentration, what happens? It is defined as a increased concentration of cells and solids in the blood from loss of fluid in the tissues. Which equals dehydration. So would the INR be increased or decreased? You are correct, it would increase. Hope this helps you understand more about having diarrhea/and or vomiting and the INR values.

CVmursenary · Jan 13, 2011

I think it would decrease, not increase.

Over-the-hill-Nurse · Jan 13, 2011

Having diarrhea or vomiting that causes dehydration makes the PT/INR longer because of poor absorption of nutrients, vitamins, specifically Vitamin K. Vitamin K is given when levels are high because it helps the blood to clot. If you have low levels of Vitamin K, the thinner the blood, which means a increase in the PT/INR.

A longer PT will also affect the clotting factors of I, II, V, VII, or X in which you have a lack of or low level of these factors causing an alteration in the PT/INR.

Marie Florestal · Jan 13, 2011

Great info guys, just signed in and already im learning.

bennett12 · Jan 20, 2011

thanks all

Quark09 · Jan 21, 2011

If you're taking out every other factor except vomiting and diarrhea (which would result in dehydration/hemoconcentration) I'd say your INR would decrease.

Edited to add: if your patient is on warfarin, though, the dehydration could result in concentrated levels of the drug in the blood, which would increase the INR.

PharmD101 · Oct 11, 2014

Actually, the reason why INR is elevated in patients with diarrhea (on warfarin) is because diarrhea causes vitamin-k producing bacteria to be expelled in the lower GI tract - which results in decreased vitamin K stores and causes an exaggerated response to warfarin.

Long Term Care Columnist / Guide · Oct 12, 2014

Thank you all for this information. My husband is on warfarin and I never even thought of this. Now I've warned him to call his anticoag nurse if he ever gets sick with N/V/D so his INR can be checked right away and appropriate measures taken.