Protein–calorie malnutrition does not predict subtle vitamin K depletion in hospitalized patients

Abstract

Objective: Recent studies suggest that subtle vitamin K depletion has far-reaching consequences. As this entity is not associated with prothrombin time elevation, it is important to determine whether alternate methods can help identify it. We investigated subtle vitamin K depletion in a hospital setting and determined whether protein ± calorie malnutrition predicts its presence. Design, setting, subjects: Using a high-pressure liquid chromatography (HPLC) assay of plasma phylloquinone and a food frequency questionnaire for phylloquinone intake, we examined the phylloquinone status of 27 hospitalized patients with normal coagulation parameters, no liver disease, and no recent warfarin use. We assessed protein ± calorie nutritional status with Reilly's criteria and anthropometrics. Results: 51% of patients (95% Cl 31% to 70%) had evidence of subtle vitamin K depletion as de®ned by a subnormal plasma phylloquinone concentration. Patients whose phylloquinone intake was less than the Recommended Daily Allowance (RDA) over the preceding year had lower plasma phylloquinone concentrations when compared to other patients: median (range) 0.106 nmolal (0.022 ± 0.461) versus 0.301 nmolal (0.067 ± 3.928), respectively (P 0.023). Plasma phylloquinone concentrations were no different, however, between well-nourished and malnourished patients: median (range) 0.245 nmolal (0.022 ± 0.522) versus 0.188 nmolal (0.067 ± 3.928), respectively (P 0.782). Conclusions: Subtle vitamin K depletion is common among hospitalized patients and protein ± calorie malnutrition does not predict its presence.

Serum Vitamins in Adult Patients With Short Bowel Syndrome Receiving Intermittent Parenteral Nutrition

“…On the basis of these reference values, it can be stated that the SBS patients of the present study presented with low plasma levels of phylloquinone (0.6 ± 0.2 nmol/L). In fact, low phylloquinone levels have been documented in 51% of hospitalized patients, regardless of the occurrence of undernutrition 37 . The correlation between vitamin K deficiency and intestinal diseases, as well as the relationship between lower serum levels of vitamin K and the long‐term use of antibiotics, has been recognized.…”

“…In fact, low phylloquinone levels have been documented in 51% of hospitalized patients, regardless of the occurrence of undernutrition. 37 The correlation between vitamin K deficiency and intestinal diseases, as well as the relationship between lower serum levels of vitamin K and the long-term use of antibiotics, has been recognized. Clinical manifestations such as bleeding and prolonged prothrombin time have been documented in celiac disease, 38 cystic fibrosis, 39 and Crohn's disease.…”

Reducing the use of coagulation test panels

“…Reducing the use of coagulation test panels Amukele et al 693 [10][11][12]. Risk factors for vitamin K deficiency include inadequate dietary intake, malabsorption (particularly with cholestatic liver disease), antibiotic therapy, renal insufficiency, and recent surgery, at times leading to unexpected coagulopathy, bleeding, and death [13,14].…”

RAREACQUIREDBLEEDINGDISORDERS

“…Celiac disease in an adult with shock due to intraperitoneal hemorrhage from vitamin K deficiency coagulopathy has been reported (164). Ill, hospitalized patients with poor nutrition may also develop a coagulopathy due to vitamin K deficiency, especially those treated with antibiotics (165), and subclinical deficiency is a common phenomenon in the hospitalized (166).…”