vitamin k deficency

overview, types of vitamin k, symptoms, cause, diagnosis, managment , prevention , diagnosis

1. VITAMIN K DEFICIENCY PRESENTED BY Dr. Qureshi Jalib

2. Vitamin K is a nutrient that the body requires in small, regular amounts. It is essential for the formation of several substances called  coagulation factors  that work together to clot the blood when injuries to blood vessels occur. Insufficient vitamin K can lead to excessive bleeding and easy bruising. Vitamin K is also thought to play an important role in the prevention of bone loss . Low blood levels of vitamin K have been associated with low bone density, and there is some evidence that adequate levels of vitamin K can improve bone health while reducing the risk of fractures. INTRODUCTION Cont.…..

3. Vitamin k is a fat soluble vitamin necessary for the synthesis(activation) of clotting factors : Clotting factor II ( prothrombin) Clotting factor VII ( proconvertin ) Clotting factor IX ( thromboplastin ) Clotting factor X ( Stuart factor)

4. Vitamin K1 ( phylloquinone or phytomenadione ) Vitamin K2 ( menaquinones ) Vitamin k3 ( Menadione ) TYPES OF VITAMIN K

5. Vitamin K1 ( phylloquinone or phytomenadione ) is the natural from of vitamin K that comes from foods, especially green leafy vegetables but also dairy products and vegetable oils. K1 is considered as the "plant form" of vitamin K, but it is also produced commercially to treat some conditions associated with excess bleeding .

6. Vitamin K2 ( menaquinones ) is made by  bacteria , the   normal flora  in the intestines. Bacteria in the intestines can also convert K1 into K2. Vitamin K2 supplements K1 from the diet to meet the body's requirements. Menaquinone is also present in animal origin foods like: Meat especially liver Cheese

7. Menadione is a non-natural, man-made chemical compound that is used in some countries as a nutritional supplement because of its vitamin K activity. It is sometimes called K3 . Menadione supplements are currently banned in the U.S. because of its potential toxicity in human use.

8. PHYSIOLOGY Vitamin K (VK) acts as a cofactor; it is needed for the conversion of 10-12 glutamic acid residue on the NH 2  -terminal of precursor coagulation proteins into the action form of gamma- carboxyglutamic acid (which occurs via VK-dependent gamma- glutamyl carboxylase).   This essential reaction allows the VK-dependent proteins to bind to surface phospholipids through calcium ion channel–mediated binding, in order to start the normal antithrombotic process. The exact mechanism by which VK functions as cofactor with the carboxylase is not fully understood. Vitamin K is required in the synthesis of 4 clotting factors in the liver: factors II,VII, IX, and X. It is also essential in the production of protein C and S, which are anticoagulant proteins.   Bone matrix proteins, specifically osteocalcin, undergo gamma carboxylation with calcium much the way coagulation factors do; this process also requires VK .

9. Vitamin k deficiency Vitamin K deficiency bleeding (VKDB) is a bleeding problem that occurs in some newborns during the first few days of life. VKDB was previously called hemorrhagic disease of the newborn.

10. Vitamin K (VK) deficiency can occur in any age group, but it is encountered most often in infancy. In infants, VK deficiency without bleeding may occur in as many as 50% of infants younger than 5 days. The classic hemorrhagic disease occurs in 0.25-1.7% of infants. The prevalence of late hemorrhagic disease in breastfed infants is about 20 cases per 100,000 live births with no prior VK prophylaxis. EPIDEMIOLOGY

11. SIGNS AND SYMPTOMS The  signs and  symptoms associated with vitamin K deficiency may include: Easy bruising Oozing from nose or gums Excessive bleeding from wounds, punctures, and injection or surgical sites Heavy menstrual periods Bleeding from the gastrointestinal (GI) tract Blood in the urine and/or stool Increased prothrombin time (PT)

12. In hemorrhagic disease of the newborn, in more serious cases, may also involve bleeding within the skull (intracranial).

13. The most common causes of vitamin K deficiency are insufficient dietary intake, inadequate absorption, and decreased storage of the vitamin due to liver disease, but it may also be caused by decreased production in the intestines . Although vitamin K deficiency is uncommon in adults, certain people are at increased risk if they: take coumarin anticoagulants such as warfarin, which thins the blood are taking antibiotics have a condition that causes the body to not absorb fat properly (fat malabsorption) have a diet that is extremely lacking in vitamin K CAUSES Cont.…..

14. Coumarin anticoagulants interfere with the production of the proteins involved in blood clotting. Some antibiotics cause the body to produce less of its own vitamin K. Other antibiotics may cause vitamin K to become less effective in the body. Fat malabsorption leading to vitamin K deficiency may occur in people with: celiac disease cystic fibrosis a disorder in the intestines or biliary tract (liver, gallbladder, and bile ducts) part of their intestine removed Cont.…..

15. Newborn infants are at increased risk for vitamin K deficiency for a variety of reasons: breast milk is very low in vitamin K vitamin K does not transfer well from a mother’s placenta to her baby the liver of a newborn infant doesn’t use the vitamin efficiently newborns don’t produce vitamin K2 on their own in the first few days of life

16. Physical exam The exam is often unremarkable. In severe cases, the individual may be weak and pale due to loss of blood. Physical findings may reveal small hemorrhagic spots in the skin (petechial), a localized collection of blood (hematoma), or oozing of blood from a puncture site.  Bruising  is common. Infants may have an underdeveloped face, nose, or bones . DIAGNOSIS Cont.….

17. Tests  Prothrombin time thrombin time  platelet count  platelet function tests coagulation factor tests  fibrinogen Cont.….

18. A deficiency of vitamin K is usually discovered when unexpected or excessive bleeding occurs. In such cases, a  prothrombin time (PT)   laboratory test is performed to investigate the bleeding. If the result is prolonged and is suspected to be due to low levels of vitamin K, then vitamin K will often be given by injection. If the bleeding stops and the PT returns to normal, then a vitamin K deficiency is assumed to be the cause.

19. Short-term treatment for vitamin K deficiency usually involves either oral supplementation or injections. Long-term or lifetime supplementation may be necessary for those with underlying  chronic conditions . The action of vitamin K typically requires 2 to 5 days after it is given to show treatment effect. TREATMENT Cont.….

20. 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. Cont.….

21. The treatment for vitamin K is the drug  phytonadione which is vitamin K1 . Dosage adults ranges from 1 to 25 milligrams taking an anticoagulant 1 to 10 mg. newborns get a single shot of 0.5 to 1 mg vitamin K1 at birth. A higher dose may be necessary if the mother has been taking anticoagulants or anti-seizure drugs. Cont .….

22. Vitamin K-dependent clotting factors are produced by the liver. If a person has chronic liver disease that person may not be able to produce sufficient clotting factors even when adequate vitamin K is available. Vitamin K supplementation may not be effective in those with seriously damaged livers. Cont .….

23. 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 . 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.

24. On an average day, nutritionists consider ; 120 mg adequate for men 90 mg adequate for women. Some foods, including leafy green vegetables, are extremely high in vitamin K and will give you all you need in one serving. A single shot of vitamin K at birth can prevent a problem in newborns. People with conditions involving fat malabsorption, taking warfarin and similar anticoagulants should speak to their doctors about taking a vitamin K supplement and having their levels monitored. PREVENTION

25. Patients with VK deficiency have a very good prognosis if the condition is recognized early and treated appropriately. No mortalities from VK deficiency have been reported. However, severe bleeding can occur if the deficiency is left untreated. Morbidity correlates with the severity of vitamin K deficiency. The risk of developing vitamin K deficiency bleeding is 81 times greater in infants who do not receive a  prophylactic vitamin K injection.     In 50% of patients with late vitamin K deficiency bleeding (VKDB), the bleeding location involves an intracranial hemorrhage, which is associated with high mortality and morbidity. PROGNOSIS

26. https:// labtestsonline.org/understanding/conditions/vitamink/start/4 http:// www.healthline.com/health/vitamin-k-deficiency#prevention7 http:// emedicine.medscape.com/article/126354-treatment http:// www.stanfordchildrens.org/en/topic/default?id=vitamin-k-deficiency-bleeding-hemorrhagic-disease-of-the-newborn-90-P02372 REFERENCES