This is a reminder of an important clinical lesson that highlights the risk of vitamin K deficiency in the critically ill. The authors give a thorough account of the presentation, possible consequences and literature review in this case making it a rewarding and educational report. I note with interest the reviewer’s comments about not wanting to suggest yet another ‘guideline’. Sometimes protocols and guidelines can make medicine appear ‘routine’ and it takes case reports such as this to remind us that the challenge is often in the unexpected.

Iatrogenic vitamin K deficiency and life threatening coagulopathy
Samuel John Ford, Alistair Webb, Richard Payne, and Norbert Blesing