Vitamin K deficiency

The main symptom of Vitamin K deficiency is uncontrolled bleeding. Other symptoms seen in adults include:

• Easy bruising
• Heavy periods
• Menstrual cramps
• Bleeding from gums and teeth
• Vomiting
• Petechiae (little red spots)
• Nose bleeding
• Jaundice
• Pale skin
• Bloody stool
• Sleepiness
• Weak bones
• Irregular heartbeats

Infants are at a higher risk of Vitamin K deficiency until they start eating regular foods or until the normal intestinal bacteria begin producing Vitamin K. The signs and symptoms typically observed in newborns and infants include:

• Hemolytic anemia (rupturing of red blood cells)
• Bleeding (hemorrhage) within the brain
• Retinopathy (damage to the retina of the eye)
• Weakened muscles
• Kernicterus (excessive bilirubin buildup in the brain)

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Vitamin K is a fat-soluble vitamin essential for blood clotting, bone health, and preventing heart calcification.

It has three forms:

• K1 from leafy greens
• K2 from fermented foods
• K3, a synthetic form, which has been replaced due to potential toxicity

Vitamin K deficiency disrupts the carboxylation (activation) of clotting factors, reducing their ability to bind to cell membranes and form blood clots.

This leads to an increased risk of bleeding due to underactive clotting proteins.

Several factors can increase the risk of vitamin K deficiency, which are discussed in the next segment.

The risk factors of Vitamin K deficiency include:

1. Inadequate dietary intake

The primary cause of Vitamin K deficiency is insufficient consumption of green leafy vegetables, such as broccoli and sprouts, fish, meat, and eggs.

2. Gastrointestinal disorders

Vitamin K is mainly absorbed in the upper small intestine. Any disease that can hinder this absorption can lead to Vitamin K deficiency.

Some of the conditions include:

• Diarrhea
• Celiac disease
• Cystic fibrosis
• Inflammatory bowel disease
• Blocked bile duct

Note: Sometimes, a part of the intestine is removed during bariatric surgery (weight loss surgery), which can also cause Vitamin K deficiency.

3. Disruption of gut bacteria

It has been estimated that up to half of the daily Vitamin K requirement is provided by gut bacteria. Any disruption in these bacteria can lead to a deficiency of Vitamin K.

4. Family history

A family history of Vitamin K deficiency can raise the risk due to genetics affecting nutrient absorption. Inherited traits may impact how the body uses Vitamin K, leading to potential deficiencies.

5. Infancy

Infants are at higher risk of Vitamin K deficiency due to limited transfer from the placenta, low levels in breast milk, and an underdeveloped gut. Babies with liver disease or whose mothers used certain medications, like isoniazid or seizure treatments, face an even greater risk.

6. What is Vitamin K deficiency bleeding (VKBD)?

VKBD refers to uncontrollable bleeding in babies due to a lack of Vitamin K. Infants who do not receive the Vitamin K shot are at higher risk of VKBD until 6 months of age.

7. Medications

The prolonged use of antibiotics and blood thinners increases the risk of Vitamin K deficiency.

Vitamin K deficiency is diagnosed by assessing symptoms, medical history, physical exams, and specific blood tests. These include:

1. Medical history and physical examination

   The doctor will inquire about your symptoms, medical history, and any relevant factors such as diet and lifestyle.

   During a physical exam for Vitamin K deficiency, they will check for signs such as easy bruising, bleeding gums, nosebleeds, or other unusual bleeding, which indicate clotting issues.

2. Laboratory tests
   • Coagulation profile: This helps detect vitamin K deficiency by showing prolonged clotting times, indicating impaired blood clotting.
   • Prothrombin time (PT) test: This blood test measures clotting time, which is longer in individuals with Vitamin K deficiency.
   • Complete blood count (CBC): This test measures red and white blood cells and platelets, helping to detect anemia from Vitamin K deficiency by revealing low red blood cell counts.
   • PIVKA-II marker: This test detects under-carboxylated proteins in the blood, indicating a Vitamin K deficiency.
   • Platelet count: It helps assess Vitamin K deficiency, as low levels may indicate impaired clotting function related to the deficiency.
   • Bleeding time: This test checks how quickly small blood vessels close to stop bleeding, with Vitamin K deficiency potentially leading to prolonged bleeding.
3. Imaging tests
   • X-rays: These can be used to assess bone density, which can be affected in severe cases of Vitamin K deficiency.
   • Magnetic resonance imaging (MRI): This scan can help in diagnosing any internal bleeding in the brain that can occur in children and adults due to Vitamin K deficiency.

Here are a few tips suggested to avoid Vitamin K deficiency:

1. Ensure sufficient intake of Vitamin K

   Make sure to get enough Vitamin K through a balanced diet or supplements to prevent deficiency.

2. Be cautious of certain medications

   The long-term use of certain medications such as antibiotics and warfarin can interfere with Vitamin K. Use them with proper medical guidance to prevent deficiency.

3. Take care of your gut

   A healthy gut microbiome aids Vitamin K absorption, so include probiotics in your diet to support this beneficial bacteria.

   Some natural examples of probiotic foods are:

   • Pickled cucumbers
   • Fermented dairy products such as coconut milk yogurt and almond milk yogurt
   • Kefir (fermented milk drink)
   • Sauerkraut (fermented cabbage)

   You can also add probiotic supplements to your diet to enhance your gut health.

Mild cases of Vitamin K deficiency can be managed through diet. Increasing the consumption of foods rich in Vitamin K can be beneficial. Other treatment options include:

• Oral Vitamin K supplements: For mild to moderate Vitamin K deficiency, oral supplements are typically prescribed in the form of Vitamin K1 supplements.
• Systemic Vitamin K supplements: In severe Vitamin K deficiency, intravenous Vitamin K may be prescribed to ensure direct absorption by bypassing the digestive system. Infants can receive a single Vitamin K1 injection at birth to prevent deficiency.
• Vitamin K Deficiency Due to Malabsorption in Infants: For infants with malabsorption, high daily oral doses of Vitamin K1 are given. Injections are considered if oral dosing isn’t effective.
• Treatment of Neonatal VKDB: Treatment for neonatal VKDB involves giving 1–2 mg of Vitamin K1 through slow IV or subcutaneous infusion. For severe bleeding, fresh frozen plasma may also be used.
• Treatment of VKCFD (Vitamin K–Dependent Clotting Factor Deficiency): VKCFD treatment includes Vitamin K1 orally 2–3 times a week, or by IV if needed. For surgeries or severe bleeding, fresh frozen plasma, prothrombin complex, or recombinant factor VII may be given.
• Prophylaxis in Newborns: Newborns typically receive Vitamin K1 via injection within their first hour. Injections are preferred due to their higher effectiveness in preventing deficiency.

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To obtain the recommended intake of vitamin K, it is advisable to consume a diverse selection of foods, including the following options:

• Add More Green Leaf: Incorporate more green leafy vegetables like spinach, kale, broccoli, and cabbage to boost Vitamin K intake and help prevent deficiency.
• Eggs: Eggs are an excellent source of Vitamin K, especially the yolks, which contain higher levels of the nutrient compared to the whites. They offer numerous benefits beyond just helping with Vitamin K deficiency.
• Milk and Other Dairy Products: Milk, along with cheese and paneer, is rich in Vitamin K and is easily absorbed in the stomach compared to other sources.
• Natto (Fermented Soy): Natto, a traditional Japanese dish made from fermented soybeans, is an excellent source of Vitamin K2. To enjoy natto, mix it with soy sauce or mustard for added flavor and serve it over warm rice as a nutritious topping.
• Fermented Milk (Kefir): Kefir is a fermented dairy drink similar to thin yogurt. It is a rich source of Vitamin K along with other vitamins and minerals. It can be consumed as is or poured over cereal or mixed in a smoothie.
• Sauerkraut: Made from fermented cabbage, sauerkraut is full of beneficial bacteria that help maintain gut microbiome balance. It can be enjoyed as a side dish, added to sandwiches, or used as a topping for sausages and salads.
• Animal-Derived Food Products: Foods such as fish (salmon, trout, sardines, and tuna), meat, and organ meats like liver are exceptionally high in Vitamin K.

Eating food doesn't always ensure proper nutrition. Here are some simple tips to boost nutrient absorption from your meals.

Vitamin K deficiency can lead to various complications and health problems. Here are some of the potential complications associated with Vitamin K deficiency:

• Bleeding: This is the most significant complication of Vitamin K deficiency and is often fatal in infants.
• Easy bruising: Individuals with Vitamin K deficiency may bruise easily. A minor bump can result in a large bruise that does not heal quickly.
• Excessive bleeding: Low levels of Vitamin K can lead to severe bleeding from wounds, especially from the gums or nose.
• Increased fracture rates: A deficiency of Vitamin K results in a loss of bone density, putting individuals at risk of developing osteoporosis. Increased rates of fractures, along with pain and aches in the joints and bones, are signs of Vitamin K deficiency.
• Cardiovascular disease: A deficiency in Vitamin K has been associated with increased calcium deposition in the heart, which may lead to cardiovascular disease.

If you or your loved ones have Vitamin K deficiency, it's important to actively monitor your heart health.

Living with a Vitamin K deficiency requires careful management and attention to your diet and overall health. The biggest concern with Vitamin K deficiency is excessive bleeding. Here are ways to control and manage bleeding episodes:

• Apply pressure: Press a clean cloth firmly against the wound to help stop the bleeding by promoting clot formation.
• Elevate the affected area: Raise the bleeding limb above the heart to reduce blood flow and minimize bleeding.
• Use ice packs: Place ice on the wound to constrict blood vessels, slowing down the bleeding process.
• Avoid movement: Keep the injured area still to prevent further damage or increased blood flow that could worsen bleeding.
• Seek medical help: If bleeding doesn’t stop or is severe, seek immediate medical attention to prevent complications. Unstoppable bleeding can be life-threatening. Learn how to give first aid in case of bleeding.

Tips For Parents

Vitamin K deficiency is common in newborns and infants. Things parents can do include:

• Follow doctor’s recommendations: Ensure prescribed Vitamin K doses or supplements are taken as advised.
• Monitor for signs of bleeding: Watch for unusual bruising, nosebleeds, or bleeding gums.
• Ensure a balanced diet: Include Vitamin K-rich foods like leafy greens and fermented foods in their diet.
• Limit medications that affect Vitamin K: Consult your doctor before giving medications that may interfere with Vitamin K absorption.
• Get regular check-ups: Keep up with pediatric visits to monitor Vitamin K levels and overall health.