Vitamin K in Bariatric Surgery

Vitamin K plays an essential role in the blood coagulation regulation through the formation of prothrombin (factor II, VII, IX. X protein C and protein S). Other functions are bone metabolism regulation (in particular osteocalcin) and regulation of vascular biology.

Vitamin K is absorbed in the jejunum and ileum in the presence of bile and pancreatic juice. Fifty percent of the daily requirement of this vitamin is derived from the intestinal flora biosynthesis and it is present in food sources such as green leafy vegetables, avocado, kiwi fruit, liver, soy and vegetable oils [48].

Vitamin K deficiency may be secondary to low intake (anorexia, alcoholics, elderly patients), fat malabsorption (e.g. cystic fibrosis, biliary atresia, gastrointestinal surgeries such as bariatric surgery), use of antibiotics that alter the intestinal bacterial flora (e.g. cephalsporins, isoniazid, rifampicin) and intake of vitamin K inhibiting drugs (e.g. phenytoin, cholestryramine) [48].

Low levels of vitamin K have been noted in 69 % of BPD/DS patients despite routine supplementation, with the deficiency being commonly asymptomatic [49].

Vitamin K deficiency results in bleeding coagulation disorders presenting as purpura, petechiae, ecchymoses, and bruising. Post bariatric pregnant females having excessive vomiting or fat malabsorption have a higher risk of vitamin K deficiency related bleeding disorders in the neonates [37]. Fetal cerebral hemorrhage was reported due to maternal vitamin K deficiency following vomiting after gastric band slippage [50]. Maternal vitamin K deficiency and related complications were documented by Eerdekens et al. in five patients with severe intracranial bleeding and skeletal malformations similar to warfarin fetopathy (Rhizomelic chondrodysplasia punctate) [51]. In the presence of an established fat-soluble vitamin deficiency with coagulopathy assessment of a vitamin K1 level should be considered.

The recommended Dietary Allowance for Vitamin K

Vitamin K

Males

Females

RDA* (India) [16]

70 mcg

60 mcg

RDA*(US) [17]

120 mcg

90 mcg

RNI**(UK) [18]

75 mcg

75 mcg

NRV***(Australia/New Zealand) [19]

70 mcg

60 mcg

RDA* recommended dietary allowances, RNI** reference nutrient intake, NRV*** nutrient reference value

 
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