K

Prothrombin time (PT) deficiency if >13.5 s

PIVKA-II deficiency if <3.0ng/ml

Severe deficiency with xerophthalmia <6months old: 50000IU PO QD x2days, then again at 2 weeks 6-12months: 100000IU PO QD x2days, then again at 2 weeks >12months: 200000IU PO QD x2days, then again at 2 weeks 1-8years: 5000lU/kg/day x5days PO, then

5000-10000 units/day x 2 months >8years and adults: 500000IU QD x3days, then 50000 units/day x14days, then 10000-20000units/day x2months

Vitamin D2 (Ergocalciferol)

Oral (Drisdol) liquid or capsule Children with malabsorption

10000-25000 USP units PO/day until normal Children with normal absorption

1000-5000 units PO x6-12 weeks IM (Calciferol)—100 000 units/ml 10 000-100000 units IM once. Larger single IM doses may be given.

Follow calcium, PTH, 25-OHD concentrations.

1 unit/kg/day of water-miscible form plus usual vitamin E supplementation until normal blood levels

1 unit = 1 mg dl-a-tocopherol acetate

Infants and children

1-2 mg single IM, SC, or IV dose Adults

10 mg single IM, SC, or IV dose

Serum level is not a good indicator of liver stores. Low in chronic infection, liver disease, or during an acute phase response. Check retinol binding protein (RBP) circulation in plasma. Assess toxicity by using molar ratio of retinol to RBP:

Retinol(mg/dl)x 0.0349 = mmol/l RBP(mg/dl)x 0.476 = mmol/l Molar ratio should be between 0.8 and 1.0. Ratios >1.0 suggest increased levels of free retinol and possible toxicity.

Low in dietary deficiency, decreased absorption, UV light deficiency, prematurity, liver disease, and with certain drugs (anticonvulsants). Higher in summer.

Watch for hypercalcemia and hypercalciuria and other signs of toxicity.

Carried exclusively on plasma lipoproteins; thus, vitamin E:total lipid ratio or vitamin E:chol + tryglycerides (TG) is a better indicator of stores than serum levels.

Conversions

Total lipids = cholesterol + TG + phospholipids Chol (mg/dl)x 0.0259 = chol (mmol/l) TG (mg/dl) x 0.0113 = TG (mmol/l) Vitamin E (mg/l)x 2.32 = vitamin E (mmol/l)

Do not give with medications that interfere with vitamin E absorption (vitamin A, cholestyramine, and antacids).

Deficiency in malabsorption, long-term antibiotic therapy.

From Corrales K (2005) Cystic fibrosis. In: Hendricks KM and Duggan C (eds.) Manual of Pediatric Nutrition, 4th edn. Hamilton, ON: BC Decker.

not contain the fatty acids linoleic and linolenic acid, which are essential to humans.

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