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Vitamin K in parenteral nutrition.
Gastroenterology 2009; 137(5 Suppl):S105-18G

Abstract

Vitamin K (as phylloquinone and menaquinones) is an essential cofactor for the conversion of peptide-bound glutamate to gamma-carboxy glutamic acid (Gla) residues in a number of specialized Gla-containing proteins. The only unequivocal deficiency outcome is a bleeding syndrome caused by an inability to synthesize active coagulation factors II, VII, IX, and X, although there is growing evidence for roles for vitamin K in bone and vascular health. An adult daily intake of about 100 microg of phylloquinone is recommended for the maintenance of hemostasis. Traditional coagulation tests for assessing vitamin K status are nonspecific and insensitive. Better tests include measurements of circulating vitamin K and inactive proteins such as undercarboxylated forms of factor II and osteocalcin to assess tissue and functional status, respectively. Common risk factors for vitamin K deficiency in the hospitalized patient include inadequate dietary intakes, malabsorption syndromes (especially owing to cholestatic liver disease), antibiotic therapy, and renal insufficiency. Pregnant women and their newborns present a special risk category because of poor placental transport and low concentrations of vitamin K in breast milk. Since 2000, the Food and Drug Administration has mandated that adult parenteral preparations should provide a supplemental amount of 150 microg phylloquinone per day in addition to that present naturally, in variable amounts, in the lipid emulsion. Although this supplemental daily amount is probably beneficial in preventing vitamin K deficiency, it may be excessive for patients taking vitamin K antagonists, such as warfarin, and jeopardize their anticoagulant control. Natural forms of vitamin K have no proven toxicity.

Authors+Show Affiliations

Centre for Haemostasis and Thrombosis, St Thomas' Hospital, London, United Kingdom. martin.shearer@gstt.nhs.uk

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19874942

Citation

Shearer, Martin J.. "Vitamin K in Parenteral Nutrition." Gastroenterology, vol. 137, no. 5 Suppl, 2009, pp. S105-18.
Shearer MJ. Vitamin K in parenteral nutrition. Gastroenterology. 2009;137(5 Suppl):S105-18.
Shearer, M. J. (2009). Vitamin K in parenteral nutrition. Gastroenterology, 137(5 Suppl), pp. S105-18. doi:10.1053/j.gastro.2009.08.046.
Shearer MJ. Vitamin K in Parenteral Nutrition. Gastroenterology. 2009;137(5 Suppl):S105-18. PubMed PMID: 19874942.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin K in parenteral nutrition. A1 - Shearer,Martin J, PY - 2009/05/21/received PY - 2009/08/14/revised PY - 2009/08/18/accepted PY - 2009/10/31/entrez PY - 2009/11/13/pubmed PY - 2010/1/7/medline SP - S105 EP - 18 JF - Gastroenterology JO - Gastroenterology VL - 137 IS - 5 Suppl N2 - Vitamin K (as phylloquinone and menaquinones) is an essential cofactor for the conversion of peptide-bound glutamate to gamma-carboxy glutamic acid (Gla) residues in a number of specialized Gla-containing proteins. The only unequivocal deficiency outcome is a bleeding syndrome caused by an inability to synthesize active coagulation factors II, VII, IX, and X, although there is growing evidence for roles for vitamin K in bone and vascular health. An adult daily intake of about 100 microg of phylloquinone is recommended for the maintenance of hemostasis. Traditional coagulation tests for assessing vitamin K status are nonspecific and insensitive. Better tests include measurements of circulating vitamin K and inactive proteins such as undercarboxylated forms of factor II and osteocalcin to assess tissue and functional status, respectively. Common risk factors for vitamin K deficiency in the hospitalized patient include inadequate dietary intakes, malabsorption syndromes (especially owing to cholestatic liver disease), antibiotic therapy, and renal insufficiency. Pregnant women and their newborns present a special risk category because of poor placental transport and low concentrations of vitamin K in breast milk. Since 2000, the Food and Drug Administration has mandated that adult parenteral preparations should provide a supplemental amount of 150 microg phylloquinone per day in addition to that present naturally, in variable amounts, in the lipid emulsion. Although this supplemental daily amount is probably beneficial in preventing vitamin K deficiency, it may be excessive for patients taking vitamin K antagonists, such as warfarin, and jeopardize their anticoagulant control. Natural forms of vitamin K have no proven toxicity. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/19874942/Vitamin_K_in_parenteral_nutrition_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(09)01468-1 DB - PRIME DP - Unbound Medicine ER -