Vitamin K deficiency

Symptoms Of Vitamin K Deficiency 

The main symptom of Vitamin K deficiency is uncontrolled bleeding. Other symptoms that are 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 heart beats

Infants are at higher risk of Vitamin K deficiency until they start eating regular foods or until the normal intestinal bacteria start making Vitamin K. The signs and symptoms that are usually seen in newborns and infants are:

• Hemolytic anemia (rupturing of red blood cells)

• Bleeding (hemorrhage) within the brain

• Retinopathy (damage of the retina of the eye) 

• Weakened muscles

• Kernicterus (excessive bilirubin build-up in the brain)

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Causes Of Vitamin K deficiency 

• 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, and the synthetic K3, now replaced due to potential toxicity.

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

• This leads to increased bleeding risk due to underactive clotting proteins.

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

Risk Factors Of Vitamin K deficiency

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, eggs, etc. 

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. 

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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 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.

What is Vitamin K deficiency bleeding (VKBD)?

VKBD refers to the 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. 

6. Medications

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

Diagnosis 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 ask 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 like easy bruising, bleeding gums, nosebleeds, or other unusual bleeding, which indicate clotting issues.

2. Laboratory tests

• Coagulation profile: It 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 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 happen in children and adults due to Vitamin K deficiency. 

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Prevention Of 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, warfarin, etc 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)

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Specialist To Visit

Medical professionals to consult in case of Vitamin K deficiency include:

• General Physician

• Pediatrician

• Gastroenterologist

• Hematologist

• Nutritionist

A general physician can diagnose and treat Vitamin K deficiency through blood tests, dietary advice, and supplementation.  

A pediatrician helps to manage the condition in children. 

A gastroenterologist helps in dealing with the deficiency developed as a result of malabsorption.

A hematologist helps in managing the bleeding episodes developed due to prolonged deficiency of Vitamin K.

A nutritionist can help with Vitamin K deficiency by assessing your dietary habits and developing a personalized meal plan to ensure adequate intake of this essential nutrient. 

When to see a doctor?

See a doctor immediately  if you experience:

• Unusual or easy bruising

• Frequent nosebleeds or bleeding gums

• Heavy or prolonged bleeding from cuts

• Blood in stool or urine

• Symptoms of anemia, like fatigue or weakness.

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Treatment Of Vitamin K Deficiency

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:

1.  Oral Vitamin K supplements

• For mild to moderate Vitamin K deficiency, oral supplements are typically prescribed in the form of Vitamin K1 supplements. 
  
  Buy Vitamin K Supplements
  
  

3. 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.

4. 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.

5. 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.

6. 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.

7. 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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Home care For Vitamin K deficiency

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, cabbage, etc to boost Vitamin K intake and help prevent deficiency. 

• Eggs (Ande): These are an excellent source of Vitamin K, especially the egg yolks which contain higher levels of the nutrient compared to the whites.
  
  Eggs offer numerous benefits beyond just helping with Vitamin K deficiency.
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• Milk and other dairy products: Milk, along with cheese and paneer, is rich in Vitamin K. It is easily and rapidly absorbed in the stomach compared to other sources.

• Natto (Fermented Soy): Natto, a traditional Japanese dish made from fermented soybeans and typically is an excellent source of Vitamin K2.
  
  How To Use It?
  To enjoy natto, simply mix it with soy sauce or mustard for added flavor and serve it over warm rice as a nutritious topping.

• Fermented milk (kefir): It is a fermented dairy drink that’s similar to a thin yogurt.  It is a rich source of Vitamin K with other vitamins and minerals too.
  
  How To Use It?
  It can be consumed as it is or poured over cereal or mixed in a smoothie. 

• Sauerkraut (Khatti gobhi): This is made from fermented cabbage. Like other fermented foods, it’s full of good bacteria that help keep your gut microbiome in balance.
  
  How To Use It?
  Sauerkraut 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 this vitamin.

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

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 because of Vitamin K deficiency and is often fatal in infants.

• Easy bruising: Vitamin K-deficient individuals get easily bruised. Sometimes, a little bump can manifest as a large bruise that does not heal quickly. 
  
  

• Excessive bleeding: Low levels of Vitamin K lead to extreme bleeding wounds, especially from the gums or nose.
  
  

• Increased fracture rates: A deficiency of Vitamin K leads to a loss of bone density. People with low levels of this vitamin leads are at risk of developing osteoporosis. 

   

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• 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 as well.
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Living With Vitamin K deficiency

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 bleeging. 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.
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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.