eMedicine Specialties > Endocrinology > Metabolic Disorders
Vitamin K Deficiency: Treatment & Medication
Updated: Dec 18, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
The medical therapy for vitamin K (VK) deficiency depends on the severity of the bleeding and the underlying pathophysiologic disease state. The most effective approach to correct the deficiency also depends on the nature of the bleeding and the risk of inducing a local hematoma at the injection site. In life-threatening bleeds, FFP should be administered prior to VK.
In adults, VK-1, a phylloquinone, should be administered subcutaneously or intramuscularly. If the PT does not normalize, good evidence exists for the presence of liver disease or DIC.
Due to the risks of hematoma formation with intramuscular or subcutaneous VK administration, an oral form of VK can be administered in 5-20 mg, depending on the severity. The absorption with the oral form is variable because it requires bile salts in the ileum for absorption. This form is used in the setting of asymptomatic VK deficiency.
VK-3, a menadione, is a synthetic, water-soluble compound used to treat VK deficiency associated with maldigestion and malabsorption syndromes; however, it is not used in newborns due to the hemolysis observed with higher doses.
In urgent situations, 10-20 mg of injectable phytonadione can be dissolved in a 5% dextrose or 0.9% isotonic sodium chloride solution to be administered intravenously at a rate not to exceed 1 mg/mL to prevent a hypersensitive or anaphylactic reaction. With an intravenous form, the patient needs to be monitored closely, because cardiopulmonary arrest and/or shock can occur in rare cases. The parenteral administration of VK-1 corrects VK deficiency in 12-24 hours.
Consultations
Consultations include those with a hematologist and a gastroenterologist.
- A hematologist can exclude other conditions that can mimic vitamin K (VK) deficiency. Bleeding time, PT/aPTT levels, and serum DCP level (PIVKA level) are ordered to assist the physician in diagnosing the VK deficiency. A hematologist can accurately interpret the laboratory results of such tests.
- A gastroenterologist is consulted only if the hematologic or dietary causes of VK deficiency are excluded. Inflammatory bowel disease, malabsorption, and parenchymal liver disease are among the causes of a VK-deficient state.
Diet
Oils, such as olive, canola, cottonseed, and soybean oils, as well as green, leafy vegetables, are rich sources of vitamin K (VK). Common vegetables, including green peas and beans, watercress, asparagus, spinach, and broccoli, as well as oats and whole wheat, are rich in VK.
Medication
In cases of vitamin K deficiency, the goals of pharmacotherapy are to correct the deficiency, reduce morbidity, and prevent complications.
Fat-soluble vitamins
These are used to supplement existing levels of essential vitamins or to replace essential vitamins that are not obtained in sufficient quantities in the diet. Vitamin K is necessary for the function of clotting factors in the coagulation cascade.3,4,14
Phytonadione (AquaMEPHYTON, Mephyton, Konakion)
Promotes liver synthesis of clotting factors. The oral form requires the presence of bile in the small intestine for absorption and is therefore not used in emergency situations. Metabolism occurs in the liver, and elimination occurs in bile and urine. Phytonadione has a more rapid and prolonged effect than does menadione (water soluble). Protect the injectable form from light at all times (it may be autoclaved).
Adult
5-25 mg/d PO, usual dose is 5-10 mg/d for blood clotting or dietary supplement; may repeat in 12-48 h
10 mg/d IM; may repeat in 8-12 h
Pediatric
Hemorrhagic disease of newborn: 1-2 mg/d IM/SC; 0.5-1 mg within 1 h of birth for prophylaxis
VK deficiency:
2.5-5 mg/d PO
1-2 mg IM/SC once
Effects of warfarin, anisindione, and dicumarol are antagonized by phytonadione; mineral oil and cholestyramine may decrease GI absorption of oral form
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Severe anaphylaxis or hypersensitivity reactions have occurred rarely during administration of IV form despite proper rate control and dilution; IV form should be administered only in ED or ICU; adverse effects (<1%) include transient flushing, hypotension (rarely), cyanosis, dizziness, tenderness at site of injection, diaphoresis, and hemolysis in neonates and in patients with G-6-PD deficiency
Blood products
Plasma is the fluid compartment of blood containing the soluble clotting factors.
Fresh frozen plasma
For use in patients with blood product deficiencies.
Adult
Dose depends on severity of coagulopathy
Initially, 2 units are administered, then more is administered as needed to control bleeding; after 4-6 U of FFP, the prothrombin level should be checked to guide further need for FFP
Pediatric
Administer as in adults; administer 2 units initially; further administration depends on the severity of coagulopathy
None reported
Documented hypersensitivity
Pregnancy
A - Fetal risk not revealed in controlled studies in humans
Precautions
Viral contamination and infection are possible but unlikely due to prescreening; ineffective in patients with factor IX inhibitors; may induce an anamnestic response
More on Vitamin K Deficiency |
| Overview: Vitamin K Deficiency |
| Differential Diagnoses & Workup: Vitamin K Deficiency |
 Treatment & Medication: Vitamin K Deficiency |
| Follow-up: Vitamin K Deficiency |
| References |
| Further Reading |
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References
Suttie JW. Vitamin K. In: Machlin L, ed. Handbook of Vitamins. New York, NY: Marcel Dekker; 1984:147.
Van Winckel M, De Bruyne R, Van De Velde S, et al. Vitamin K, an update for the paediatrician. Eur J Pediatr. Nov 4 2008;[Medline].
Shearer MJ. Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Rev. Sep 18 2008;[Medline].
van Hasselt PM, de Koning TJ, Kvist N, et al. Prevention of vitamin K deficiency bleeding in breastfed infants: lessons from the Dutch and Danish biliary atresia registries. Pediatrics. Apr 2008;121(4):e857-63. [Medline].
Beutler E, Lichtman MA, Coller BS. Disorders of the vitamin K dependent coagulation factors. In: Williams Hematology. 5th ed. New York, NY: McGraw-Hill; 1995:1481-5.
Furie B, Furie BC. Molecular basis of vitamin K-dependent gamma-carboxylation. Blood. May 1 1990;75(9):1753-62. [Medline]. [Full Text].
Udall JA. Human sources and absorption of vitamin K in relation to anticoagulation stability. JAMA. Oct 11 1965;194(2):127-9. [Medline].
Furie B. Vitamin K: metabolism and disorders. In: Hoffman R, Benz EJ, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. New York, NY: Churchill Livingstone; 2000:1958-62.
Booth SL, Al Rajabi A. Determinants of vitamin K status in humans. Vitam Horm. 2008;78:1-22. [Medline].
Ansell JE, Kumar R, Deykin D. The spectrum of vitamin K deficiency. JAMA. Jul 4 1977;238(1):40-2. [Medline].
Lee GR, Bithell TC, Forester J. Acquired coagulation disorders. In: Wintrobe's Clinical Hematology. 1993. Baltimore, Md: Williams & Wilkins; 1473-80.
Krasinski SD, Russell RM, Furie BC. The prevalence of vitamin K deficiency in chronic gastrointestinal disorders. Am J Clin Nutr. Mar 1985;41(3):639-43. [Medline]. [Full Text].
Liebman HA, Furie BC, Tong MJ. Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med. May 31 1984;310(22):1427-31. [Medline].
Merli GJ, Fink J. Vitamin K and thrombosis. Vitam Horm. 2008;78:265-79. [Medline].
Klebanoff MA, Read JS, Mills JL, et al. The risk of childhood cancer after neonatal exposure to vitamin K. N Engl J Med. Sep 23 1993;329(13):905-8. [Medline]. [Full Text].
Keywords
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