What is the treatment for a patient with a Vitamin K1 (phylloquinone) level less than 10 ng/mL, indicating Vitamin K1 deficiency?

From the Guidelines

The treatment for a patient with a Vitamin K1 level less than 10 ng/mL involves oral Vitamin K1 supplementation at a dose of 1-10 mg/day, depending on age and severity of deficiency, as recommended by the espen-espghan-ecfs guidelines 1. When considering the treatment for Vitamin K1 deficiency, it's crucial to evaluate the patient's overall health status, including the presence of any underlying conditions such as cystic fibrosis, liver disease, or malabsorption, which may impact the severity of the deficiency and the required dose of supplementation. Key factors to consider in the treatment plan include:

• The patient's age, as the recommended dose varies from 0.3-1.0 mg/day for infants to 1-10 mg/day for older children and adults 1
• The severity of the deficiency, with higher doses considered for those with low vitamin K levels or at higher risk due to factors such as long-term antibiotic use 1
• The potential for malabsorption, which may necessitate higher doses or alternative administration routes, such as parenteral supplementation
• The importance of dietary counseling to increase intake of Vitamin K-rich foods, which can help maintain adequate levels and reduce the need for long-term supplementation Monitoring of coagulation parameters, such as prothrombin time, is also essential during treatment, particularly in patients with bleeding complications or those on anticoagulants, as Vitamin K supplementation can impact their effectiveness 1.

From the Research

Vitamin K1 Deficiency Treatment

• A patient with a Vitamin K1 level less than 10 ng/mL may be treated with vitamin K1 supplementation, as indicated by a study on patients with severe acute liver disease, where intravenous (i.v.) phylloquinone (vitamin K1) was given to exclude vitamin K deficiency 2.
• The treatment may involve oral or intravenous administration of mixed-micellar phylloquinone (vitamin K1), with i.v. administration showing more reliable results in patients with severe acute liver dysfunction 2.
• Dietary changes may also be recommended, including increased consumption of leafy green vegetables and certain vegetable oils, which are rich in vitamin K1, as these foods can provide sufficient vitamin K1 to support bone health and prevent deficiency 3, 4.

Pharmacokinetics and Efficacy

• The pharmacokinetics and efficacy of oral versus intravenous mixed-micellar phylloquinone (vitamin K1) have been studied in patients with severe acute liver disease, showing that i.v. administration is more effective in correcting vitamin K deficiency 2.
• The intestinal absorption of mixed-micellar K1 is unreliable in adults with severe acute liver dysfunction, making i.v. administration a more reliable option 2.
• The efficacy of phylloquinone (K1) has been compared to that of menaquinone-4 (MK-4) in vitamin K-deficient rats, showing that K1 is at least two-fold more effective in normalizing blood coagulation factor synthesis 5.

Dietary Recommendations

• Increasing dietary intake of vitamin K1-rich green leafy vegetables has been shown to have beneficial effects on bone metabolism, including reduced serum undercarboxylated osteocalcin levels 4.
• A diet rich in vitamin K1 may help prevent vitamin K deficiency and support overall health, particularly in individuals with increased risk of deficiency, such as those with liver disease or chronic kidney disease 3, 6.