VITAMIN K

DEFICIENCY
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VITAMIN K

Fat soluble vitamin
Exist in two naturally occuring forms :
- Phyloquinone (vit K1)
Main dietary source of vit K
Predominantly in leafy green vegetable
- Menaquinones (vit K2)
Restricted in the diet
Largely synthesized by intestinal bacteria
Etiology
- Uncommon in infancy
- Almost always a secondary event
resulting from : inadequate intake
or absorption, poor utilization of vit K,
or vit K antagonism (warfarin therapy)
- Condition associated with malabsorption
commonest cause of def vit K
- Liver disease
- Inadequate bile salt secretion


Clinical Features
- Bleeding (infrequent and occur in mild
and moderate vit K def)
- Bruising and oozing (from venipuncture
site)
- Internal Bleeding (rare)
- Underlying cause identified from
history and physical examination
Laboratorium :
- F II, VII, IX, X
- Prolongation of PT and aPTT
- Decarboxyprothrombin (PIVKA II)
Treatment
- Oral Vitamin K, if :
- No or only minor bleeding
- Normal absorbtion
- Parenteral Vitamin K
- Most rapid correction of vit K
- Route : Subcutaneus, Intravenous,
Intramuscular avoided (hematoma)
- Replacement Therapy :
- FFP
- Prothrombin Complex Concentrate (PCC)
- Four-Factor concentrate
Prophylaxis
- Vit K1g/kgadequate daily
requirementgiven to children at high
risk of developing deficiency
- Greatest risk of deficiency vit K :
- Severe liver disease
- Major small bowel resection
- Pulmonary disease with long term use
of antibiotic
- Pancreatic insufficiency


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