Acquired Vitamin K Deficiency Presenting as a Catastrophic GI Bleed in a Hospitalized Patient

72 y/o male with history of Insulin dependent Diabetes mellitus, hypertension, hyperlipidemia was brought to the ER from nursing home with frequent symptomatic hypoglycemic episodes. History was positive for chronic poor PO intake, and 2-day history of abdominal discomfort, dysuria and loose stools. He was found to have tenderness in left lower quadrant, guaiac positive stool and occult blood in urine. 

Initial labs showed Hb=11.7, WBC=5.7, platelet=238, creatinine=1.5, albumin=1.8, pre-albumin=8 (normal 18-45), AST=13, ALT<6, ALP=118, INR=1, PT=11, PTT=37.  Urinalysis showed positive leucocyte esterase and 80 WBCs. CT abdomen showed recto sigmoid colitis. The patient was started on ceftriaxone and metronidazole, made NPO for 2 days, and slowly advanced to a regular diet by day 4. On day 6, he had a massive lower GI Bleed with hemodynamic instability requiring ICU transfer. Technetium scan showed bleeding from recto-sigmoid area. Read more...................