Vitamin K deficiency is caused by a totally inadequate supply, a fat malabsorption, or the use of Kumarinantikoagulanzien. It is particularly common in breastfed infants, and impaired blood clotting. A suspicion results from findings routinely performed coagulation tests and is confirmed when vitamin K is effect. Therapeutically Vitamin K is given orally or parenterally when a fat malabsorption, or if the risk of bleeding is the cause high.
Vitamin K1 (phylloquinone) is contained in foods Vitamin K. dietary fat promotes its absorption. Baby food contains supplemental vitamin K.
(See also overview of vitamins.) Vitamin K1 (phylloquinone) is contained in foods Vitamin K. dietary fat promotes its absorption. Baby food contains supplemental vitamin K. Vitamin K2 refers to a number of components (menaquinones), which are synthesized by intestinal bacteria; the amount produced does not cover the vitamin K requirement. Vitamin K controls the formation of the coagulation factors II (prothrombin), VII, IX and X in the liver (see table: sources, functions and effects of vitamins). Other vitamin K-dependent coagulation factors are protein C, protein S and protein Z; the proteins C and S are among the anticoagulants. Vitamin K is maintained in metabolic processes. Once Vitamin K was involved in the formation of clotting factors, the reaction product, Vitamin K epoxide is enzymatically converted into the active form, the vitamin K hydroquinone. Thus vitamin K-dependent proteins can be active, they need calcium. The vitamin K-dependent proteins osteocalcin and gamma Carboxyglutamyl (Gla) protein has an important role to play in the bone and other tissues. In Japan and other countries, the administration of vitamin K forms is the usual treatment for osteoporosis. Vitamin K deficiency of vitamin K deficiency is caused by a totally inadequate supply, a fat malabsorption, or the use of Kumarinantikoagulanzien. It is particularly common in breastfed infants, and impaired blood clotting. A suspicion results from findings routinely performed coagulation tests and is confirmed when vitamin K is effect. Therapeutically Vitamin K is given orally or parenterally when a fat malabsorption, or if the risk of bleeding is the cause high. A vitamin K deficiency lowers blood levels of prothrombin and other vitamin K-dependent coagulation factors. He thus leads to abnormalities of blood clotting and bleeding. Worldwide Vitamin K deficiency leads to infant morbidity and mortality. A vitamin K deficiency causes bleeding in the newborn, usually 1-7 days post partum In affected newborn birth trauma can cause intracranial hemorrhage. A late form of the disease can occur in infants who are about 2 to 12 weeks old, usually in children who are breastfed and received no vitamin K supplements. Did the mother Phenytoinantikonvulsiva, Kumarinantikoagulanzien or cephalosporin antibiotics taken, there is an increased risk of bleeding. In healthy adults, a vitamin K deficiency hardly occurs because the vitamin is abundant in green vegetables and synthesize the intestinal bacteria menaquinones. Etiology Newborns are the following reasons susceptible to vitamin K deficiency: The placenta transmits lipids and vitamin K relatively poor. The neonatal liver is immature regarding the Prothrombinsynthese. Breast milk contains approximately 2.5 mcg / l little vitamin (cow’s milk contains 5000 mcg / l) K. The newborn gut is sterile during the first days of life. In adults, a vitamin K deficiency can result from fat malabsorption (z. B. due to biliary obstruction, malabsorption, cystic fibrosis or resection of the small intestine) affect the use of coumarin anticoagulants Kumarinantikoagulanzien the synthesis of vitamin K-dependent coagulation proteins (factors II, VII, IX and X) in the liver. Certain antibiotics such as cephalosporins and other broad spectrum antibiotics, salicylates, over-dose vitamin E and increase hepatic insufficiency in patients with vitamin K deficiency bleeding risk. An inadequate intake of vitamin K probably caused not Symptome.Symptome and discomfort A deficiency manifests itself usually by bleeding. Fast bruising and mucosal bleeding, especially epistaxis, gastrointestinal bleeding, menorrhagia and hematuria occur. Puncture or incision sites bleed after strong. Hemorrhages in newborns and infants may cutaneous, gastrointestinal, intrathoracic or at worst cause cerebral hemorrhage. developed an obstructive jaundice, bleeding start at most after 4 or 5 days. They show up first as slow seepage from a surgical incision, the gums, nose or gastrointestinal mucosa or as massive bleeding in Verdauungstrakt.Diagnose Usually due to prolonged prothrombin time or increased INR (International rormalized ratio), the after phytonadione suspicion of vitamin K deficiency or antagonism is lowered by Kumarinantikoagulanzien when it comes in a patient at risk to abnormal bleeding. Control of blood clotting confirms the diagnosis first. The prothrombin time is prolonged and the INR (international normalized ratio) increased, the thromboplastin time (PTT), thrombin time, platelet count, bleeding time and the values ??for fibrinogen, split by fibrinolysis substances and D-dimer are, however, within the normal range. 1 mg shortened phytomenadione i.v. (Designation of vitamin K1 of the United States Pharmacopeia, USP), prothrombin time (. N. D .: Redakt INR) within 2-6 h clearly is a liver damage is not the cause of bleeding, the diagnosis of vitamin K deficiency is therefore approved. Partly hospitals can determine a vitamin K deficiency directly by the serum vitamin level is measured. Of vitamin K1 that is between 0.2 and 1.0 ng / ml in healthy people to take the adequate vitamin K1 levels (50-150 mcg / day). to inquire about the vitamin K intake, is for a better assessment of serum value. The recent intake of the vitamin affects the serum levels, but not to the content in the tissue of. More accurate methods of determining the vitamin K status as PIVKA (protein induced in v itamin K absence or antagonism) and inadequate carboxylated osteocalcin are currently untersucht.Therapie phytomenadion Whenever possible, should phytomenadion orally or s.c. are administered. The adult dose is 1-20 mg. (Even if phytomenadion is properly dissolved and infused slowly, intravenous supplementation of vitamin can in rare cases, anaphylactic shock or similar reactions lead). The INR usually shortened to within 6-12 hours. The Phytomenadiondosis can be given after 6-8 hours again when the INR has not been reduced satisfactorily. 1-10 mg phytomenadione are indicated for the Non-emergency correction prolonged INR of patients taking anticoagulants. The levels return to normal within 6-8 h. Is only a relative correction of INR desired for. B. when the time should be slightly extended due to a replaced heart valve, even lower dose may phytomenadione (1-2.5 mg) are administered. In infants, bleeding may occur due to vitamin K deficiency s.c. by a single dose of 1 mg phytomenadion or i.m. Getting corrected. The administration is repeated if INR remains elevated. A higher dose may be necessary if the mother anticoagulants einnimmt.Prävention The im injection of 0.5-1 mg phytomenadione (or 0.3 mg / kg for premature babies) is recommended for all newborn babies within the first 6 hours after birth to reduce the incidence of intracranial hemorrhage due to birth trauma and classical hemorrhagic disease of the newborn (increased risk of bleeding 1-7 days after birth). Phytomenadion is administered prophylactically prior to surgery. Sometimes doctors recommend pregnant women taking anticonvulsants, one month before the due date until the birth of once-daily oral 10 mg phytomenadion or take in the last two weeks before the date 20 mg once daily orally. The low vitamin K1Gehalt in breast milk can be increased if the mother her Phyllochinonzufuhr by a change in diet to 5 mg / day steigert.Wichtige points vitamin K deficiency results worldwide infant morbidity and mortality. The deficiency causes bleeding (eg. As fast bruising, mucosal bleeding). A suspected the defect is in risk patients with abnormal or excessive bleeding. Before and after the application of phytomenadion prothrombin time or INR is to be measured; lowering the prothrombin time prolonged or increased INR after the administration of phytomenadione confirms the diagnosis. Treatment consists po in the gift of phytomenadion or s.c. Vitamin-K-intoxication vitamin K1 (phylloquinone) acts not toxic when, regardless of the quantity, is taken orally. However menadione, a synthetic water-soluble vitamin K-precursor, cause poisoning and should therefore can not be used for the treatment of a vitamin K deficiency.