vitamin-k-1 and Cholestasis

Topics: Adult; Alkylation; Biological Transport; Celiac Disease; Cholestasis; Dietary Fats; Feces; Humans; Infant; Intestinal Absorption; Intestines; Lipid Metabolism; Malabsorption Syndromes; Oxides; Pancreatitis; Tritium; Vitamin K; Vitamin K 1; Warfarin

To evaluate the efficacy of oral menadiol compared to intravenous phytomenadione when correcting coagulopathies associated with cholestasis.. A total of 26 patients with cholestasis and an international normalized ratio (prothrombin time) greater than 1.2, were randomized to receive either 20 mg o.d. for 3 days of oral menadiol (n=12), or 10 mg o.d. of intravenous phytomenadione (n=14) prior to endoscopic retrograde cholangeopancreatography. Liver function tests and international normalized ratio were measured daily for 3 days.. Liver function tests and international normalized ratio were comparable between groups at entry into the study (P > 0.05), but serum albumin was significantly lower in the intravenous phytomenadione group following treatment (P < 0.05). A decrease in international normalized ratio occurred in both groups following administration of vitamin K (P < 0.05). Two patients in the intravenous group required fresh frozen plasma, as failure to normalize international normalized ratio was observed. No adverse drug reactions were observed in either group, and no patient required re-admission for bleeding during a 4-week follow-up period after cholangeopancreatography.. Oral menadiol appears to be an effective alternative to intravenous phytomenadione in the correction of coagulopathies associated with obstructive liver disease. This simplifies the care of patients with deranged clotting times requiring cholangeopancreatography, particularly those to be managed as out-patients.

Topics: Aged; Aged, 80 and over; Blood Coagulation Disorders; Cholestasis; Female; Humans; Male; Middle Aged; Prothrombin Time; Vitamin K; Vitamin K 1

Eleven patients with cholestatic jaundice had measurements of plasma vitamin K1 performed. Seven of these 11 (64%) had subnormal levels. The prothrombin time (PT) was prolonged in three of 15 patients with cholestasis (20%), the patient with the longest PT had the lowest vitamin K1 level. A single intramuscular (im) dose of 10 mg vitamin K1 lowered the PT in 9/15 patients (includes correcting the three prolonged PTs). The initial mean plasma vitamin K1 level rose 24 h later, to a mean plasma level which was 33 times the upper limit of the normal physiological range. These preliminary results suggest that a majority of patients presenting with cholestatic jaundice have low tissue reserves of vitamin K1, and that guidelines for vitamin K1 therapy in patients with cholestatic jaundice should be revised.

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Blood Coagulation Disorders; Blood Coagulation Tests; Cholestasis; Digestive System Neoplasms; Female; Humans; Male; Middle Aged; Prospective Studies; Vitamin K 1; Vitamin K Deficiency

Topics: Breast Feeding; Cerebral Hemorrhage; Cholestasis; Exchange Transfusion, Whole Blood; Female; Humans; Infant; Male; Vitamin K 1; Vitamin K Deficiency

In cholestatic diseases, the absorption of fat-soluble compounds, including vitamin K1(20), is low and periodic administration of vitamin K1(20) is often necessary. Due to the low absorption of vitamin K1(20) from the Konakion formulation, late hemorrhagic disease of the newborn also occurs especially after oral vitamin K1(20) prophylaxis with Konakion. We investigated the pharmacokinetics and the safety of a new formulation of vitamin K1(20) in a mixed micelles (MM) solution. Compared to the old formulation (Konakion) using Cremophor EL as a solubilizer, the higher vitamin K1(20) levels (as measured by HPLC) in serum obtained after oral administration of the MM formulation clearly demonstrate a superiority of this new formulation. Additionally, the elimination of Cremophor EL as well as of propylene glycol from the formulation avoids possible adverse effects associated with intravenous or intramuscular administration. Furthermore, in most cases, the discomfort of parenteral injections can be overcome by simple oral administration even in children with severe cholestasis.

Topics: Administration, Oral; Blood Cell Count; Child, Preschool; Cholestasis; Drug Evaluation; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Liver; Micelles; Solutions; Vitamin K 1

Factor VII levels have been measured in 100 patients with liver disease following parenteral vitamin K1 therapy. There was good agreement between specific factor VII measurements and the one-stage prothrombin time apart from six patients with compensated cirrhosis in whom the prothrombin time was prolonged despite the presence of normal factor VII levels. A mean activity of 58% was found in patients with cirrhosis. Cirrhotic patients with features of hepatic decompensation had a significantly lower mean level of activity (40%) than the "contrast" patients with surgical obstruction of the major bile ducts (93%). Patients with chronic active liver disease had moderate depression of factor VII levels and those with non-cirrhotic liver damage had mean activities similar to the contrast group. Factor VII levels could not be correlated with BSP retention but there was a correlation with serum albumin concentration. It is concluded that the prothrombin time using Quick test with a standardized thromboplastin showing good sensitivity to factor VII, eg, the Manchester reagent (BCT), provides a reliable index of coagulability in chronic liver disease, and specific factor VII assays are not indicated.

Topics: Cholestasis; Chronic Disease; Factor VII; Humans; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Prothrombin Time; Vitamin K 1

Topics: Bile; Bile Duct Neoplasms; Biliary Tract; Biliary Tract Diseases; Cholangiography; Cholelithiasis; Cholestasis; Contrast Media; Diagnosis, Differential; Female; Gallstones; Hemorrhage; Hepatitis; Humans; Liver Diseases; Male; Methods; Neoplasm Metastasis; Pancreatic Neoplasms; Peritonitis; Prothrombin Time; Vitamin K 1

Topics: Angiography; Anti-Bacterial Agents; Biliary Tract; Biliary Tract Diseases; Bilirubin; Biopsy; Cholangiography; Cholecystography; Cholestasis; Humans; Iodipamide; Laparotomy; Liver; Liver Function Tests; Prothrombin; Radionuclide Imaging; Vitamin K 1

Topics: Adult; Aged; Biological Transport; Cholecalciferol; Cholestasis; Chromatography, Gel; Chromatography, Thin Layer; Chylomicrons; Female; Humans; Intestinal Absorption; Lymph; Male; Middle Aged; Thoracic Duct; Triglycerides; Tritium; Vitamin E; Vitamin K 1

Topics: Acetates; Aged; Alkenes; Amines; Biological Transport; Carbon Isotopes; Cholecalciferol; Cholestasis; Diet; Fatty Acids; Female; Humans; Intestinal Absorption; Lymph; Middle Aged; Thoracic Duct; Tritium; Vitamin E; Vitamin E Deficiency; Vitamin K 1