Medical Care
The medical therapy for VK deficiency depends on the severity of the bleeding and the underlying pathophysiologic disease state. The most effective approach to correct the deficiency also depends on the nature of bleeding and the risk of inducing a local hematoma at the injection site. In life-threatening bleeds, FFP should be administered prior to VK.
In adults, VK-1, a phylloquinone, should be administered subcutaneously or intramuscularly. If the PT does not normalize, good evidence exists for the presence of liver disease or DIC.
Due to the risks of hematoma formation with intramuscular or subcutaneous administration, an oral form of VK can be administered in 5-20 mg, depending on the severity. The absorption with the oral form is variable because it requires bile salts in the ileum for absorption. This form is used in the setting of asymptomatic VK deficiency.
VK-3, a menadione, is a synthetic water-soluble form used to treat VK deficiency associated with maldigestion and malabsorption syndromes; however, it is not used in newborns due to the hemolysis observed with higher doses.
In urgent situations, 10-20 mg of injectable phytonadione can be dissolved in a 5% dextrose or 0.9% isotonic sodium chloride solution to be administered intravenously at a rate not to exceed 1 mg/mL to prevent a hypersensitive or anaphylactic reaction. With an intravenous form, a patient needs to be monitored closely because cardiopulmonary arrest and/or shock can occur in rare cases. The parenteral administration of VK-1 corrects VK deficiency in 12-24 hours.
Diet
Green leafy vegetables and oils, such as olive, canola, cottonseed, and soybean, are sources rich in VK. Common vegetables, such as green peas and beans, watercress, asparagus, spinach, and broccoli, as well as oats and whole wheat, are rich in VK.
DRUG THERAPY :
1. PHYTONADIONE