Vitamin K Deficiency Treatment & Management

  • Author: Dieu-Thu Nguyen-Khoa, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Feb 23, 2012
 

Approach Considerations

The medical therapy for vitamin K (VK) deficiency depends on the severity of the associated bleeding and the underlying disease state. The most effective approach to correcting the deficiency also depends on the nature of the bleeding and the risk of inducing a local hematoma at the VK injection site. In life-threatening bleeds, fresh frozen plasma should be administered prior to VK.

In adults, VK-1 should be administered subcutaneously or intramuscularly. If the PT does not normalize after VK supplementation, then consideration should be made for the presence of liver disease or DIC.

If there is a high risk for hematoma formation with intramuscular or subcutaneous VK administration, then an oral form of VK can be administered in 5- to 20-mg doses, 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 (VK-1) can be dissolved in a 5% dextrose or 0.9% normal saline to be administered intravenously at a rate not to exceed 1 mg/mL to prevent a hypersensitive or anaphylactic reaction. When giving VK in the 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.

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Consultations

Consultations should be considered with a hematologist and a gastroenterologist.

A hematologist can exclude conditions that can mimic VK deficiency. Bleeding time, PT/aPTT, and serum DCP level (PIVKA level) are ordered to assist the physician in diagnosing the VK deficiency. A hematologist can aid in the interpretation of laboratory results.

A gastroenterologist is consulted when the hematologic or dietary causes of VK deficiency are excluded. They can help diagnose inflammatory bowel disease, malabsorption, and parenchymal liver disease that can cause a VK-deficient state.

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Diet

Oils, such as olive, canola, cottonseed, and soybean oils, as well as green, leafy vegetables, are rich sources of VK. Common vegetables, including green peas and beans, watercress, asparagus, spinach, and broccoli, as well as oats and whole wheat, are rich in VK.

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Contributor Information and Disclosures
Author

Dieu-Thu Nguyen-Khoa, MD  Associate Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician Specialist, Department of Primary Care and Community Medicine, ValleyCare Olive View-UCLA Medical Center

Dieu-Thu Nguyen-Khoa, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Pankaj Patel, MD  Fellow, Department of Gastroenterology, Winthrop University Hospital and The School of Medicine at Stony Brook University Medical Center

Pankaj Patel, MD is a member of the following medical societies: American College of Gastroenterology and American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Mageda Mikhail, MD  Assistant Professor, Department of Medicine, Division of Endocrinology, The School of Medicine at Stony Brook University Medical Center

Mageda Mikhail, MD is a member of the following medical societies: Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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