THE INFLUENCE OF PERSISTENT DIARRHEA ON VITAMIN K STATUS

Abstract

D iarrhea is an important cause of morbidity and mortality in developing countries, especially in infants and young children. In some cases, morbidity and mortality are related to vitamin K deficiency. Vitamin K is synthesized by intestinal bacteria, and deficiency of vitamin K does not occur in healthy infants given a normal diet. However, in the presence of diarrhea or with use of an antibiotic, which may cause suppression of intestinal bacteria, vitamin K deficiency may occur as the result of incomplete carboxylation of procoagulant Factors II, VII, IX, and X. Vitamin K deficiency is an important cause of acquired bleeding diathesis in neonates and infants. Deficiency of vitamin K in infants with diarrhea is probably more frequent and more severe in developing countries because of the increased likelihood of malnutrition and lack of vitamin K supplementation at birth. Newborn babies are at particular risk of vitamin K deficiency, as placental transfer is limited and human milk is a poor source. A minimal amount of vitamin K passes through the placenta, and a negligible amount is also found in breast milk. Factors including failure to administer vitamin K at birth, exclusive breastfeeding for a long period, prolonged or chronic diarrhea, and prolonged use of antibiotics could lead to bleeding because of vitamin K deficiency.