Quick’s value

Method Intravenous administration of 10 mg vitamin K in cases with a Quick s value of <70%. Diagnostically, a return to normal levels of >75% within 24 hours excludes liver disease, but favours vitamin K deficiency. A non-increase in the value indicates liver disease, since the synthesis of factors II, VII, IX and X does not depend on the administration of vitamin K. 

Endogenous functional values (e. g. albumin, cholinesterase, Quick s value, bile acids) as well as exogenous test... 

Antipyrine is oxidized through biotransformation, independently of perfusion, predominantly in the micro-somes, and is excreted after hydroxylation and conjugation. After oral administration (15 or 18 mg/kg BW, respectively), the metabolic clearance ability of the liver (metabolic capacity of the microsomal monooxygenase system) can be assessed by computation of the concentration curve and the plasma half-life (after 3 and 24 hours). The serum half-life and plasma clearance are significantly enhanced/decreased, depending on the reduction in liver function. There is a close correlation with the galactose elimination capacity as well as with Quick s value. (58-60, 74, 88)... 

Enzymatic activity 2. Synthesis capacity 3. Excretion capacity GPT, y-GT — ChE, — Quick s value AP, bile pigments — in the urine GOT, GDH — albumin — bilirubin, LAP — LDH ammonia, galactose EC bile acids, iron, copper, cholesterol, indocyanine green, LPX... 

Threshold values for blood coagulation may only be taken as guidelines. They have to be critically assessed in each individual case. Recommendations for percutaneous biopsy in hospitalized patients are (7.) Quick s value >60%, (2.) bleeding time < 3(-4) minutes, and (3.) thrombocytes >100,000, although the function of the thrombocytes is more important than their mere number. Even with reduced coagulation parameters, biopsy can still be carried out following the administration of vitamin K, fresh frozen plasma, etc. 

Quick s value, thrombocyte count, bleeding time... 

Hepatic arteriography is contraindicated in cases of severe coagulation disorders. Cut-off values are deemed to be Quick s value of >60%, thrombocytes of >100,000, and bleeding time of <3 minutes. These figures only serve as a guide a more careful assessment must be made in each individual case. In the presence of renal failure, the use of contrast media, and thus arteriography, is contraindicated. 

Quick s value can be reduced in long-term cholestasis by vitamin K deficiency (owing to a disorder in the synthesis of clotting factors dependent on vitamin K). In this respect, the intravenous Roller test can facilitate the differential diagnosis between dysfunction of synthesis... 

Latent and compensated forms of consumptive coagulopathy frequently occur in the course of severe acute or chronic liver disease. In 80-85% of cirrhosis patients, the values of at least one basic test (thrombocytes. Quick s value, fibrinogen, AT III, bleeding time) are pathological. In 15-30% of cases, clinically relevant haemorrhagic diathesis evolves. 

Vitamin K 10 mg, subcutaneous administration, to be repeated for 3 to 7 days until the prothrombin time has been corrected. Be careful when using the intravenous route due to the risk of anaphylaxis and hypotension. Onset of action is within 6-12 hours, full impact is at 24 hours, subsequently lasting up to 7 days. An overdose should be avoided as it can cause a (sudden and dangerous) drop in Quick s value resulting from the formation of vitamin K oxide. 

Laboratory parameters Once the initial blood sample has been taken to assess the blood loss, the following values must be determined immediately blood group, thrombocyte count, Quick s value, electrolyte profile and creatinine as well as fibrinogen and AT III levels. 

Volume replacement should not increase the CVP beyond 4-5 cm H2O or the haematocrit beyond 35%, since there is a danger of recurrent bleeding from the oesophageal varices in the event of overcompensation. Haemostasis parameters (e.g. thrombocyte count. Quick s value, fibrinogen, AT III) must be continually monitored, so that any need for volume replacement is recognized immediately. A torsade de pointes (special form of ventricular tachycardia) may arise in the case of an electrolyte imbalance combined with vasopressin and neuroleptics. (88) (s. fig. 19.8)... 

The compensated stage does not usually display any signs of liver insufficiency (except possibly jaundice), nor are there any typical ailments. Functional parameters that can be quantified in routine laboratory tests (such as cholinesterase, albumin. Quick s value, bile acids) may still be normal or only minimally impaired in the individual instance. In contrast, liver tolerance tests (galactose, indocyanine green, etc.) demonstrate a reduction of liver function which is already quite considerable. 

Quick s value A drop in the coagulation factors II, V, Vn, IX and X is a reliable indicator of the still remaining liver function. Factor VIII increases. With massive liver cell destruction, a dangerous decrease in factors V and VII is witnessed within 1 or 2 days (corresponding to the half-life of the factors) together with a reduction in Quick s value and Colombi s index (<60 - 80%). (45, 47, 71) (s. p. 105)... 

In the later course of disease, slight increases in IgA and IgG may be detected, (s. tab. 5.15). HBsAg is absent from the serum in approx. 90% of cases within 2-4 months. A lower Quick s value due to reduced absorption of vitamin K normalizes swiftly following the parenteral substitution of vitamin K (so-called Roller s test). The possible detection of antibodies (e.g. SMA, ANA, SLA, LMK) is of no significance. The return of bile acid values to normal constitutes a sensitive parameter for the regression and healing of the disease. 

The diagnosis is established by determining the specific YF IgM antibodies and/or the virus RNA. Laboratory parameters reveal an elevation of the transaminases, GDH, y-GT and LDH as well as a reduction in leucocytes, Quick s value and cholinesterase. Albuminuria is also present. Mortality (5-10%) is generally due to renal insufficiency. After recovery, immunity is lifelong. 

We observed a lethal case (treatment with doxycycline was unsuccesful) showing massive amounts of leptospirae in the serum and in the centrifuged urine under dark-field examination. Maximum values were GPT 4,200 Ull, GOT 2,290 Ull, GDH 1,080 Ull, serum bilirubin 11 mgldl and Quick s value 17%, but with normal AP ( ) such pathological levels have repeatedly been reported in the literature. Autopsy revealed severe interstitial nephritis, tubular necrosis (laboratory findings corresponding to severe renal insufficiency), brain oedema (680 g), severe... 

---