A subsequent clinical trial found that MK-7 supplementation (180 mcg/day for 3 years) improved bone strength and decreased the loss in vertebral height in the lower thoracic region of the vertebrae in postmenopausal women [38]. [, Booth SL, Tucker KL, Chen H, Hannan MT, Gagnon DR, Cupples LA, et al. However, the effect of vitamin K (if given simultaneously) is usually achieved within 4-6 hrs. The FDA has not authorized a health claim for vitamin K in the United States. ����ȜL>� �>.\���FB�CFG6�2�| Participants in this study who had dietary menaquinone intakes in the mid tertile (21.6–32.7 mcg/day) and upper tertile (>32.7 mcg/day) also had a 27% and 57% lower risk of coronary heart disease mortality, respectively, than those in the lower tertile of intake (<21.6 mcg/day). Food Labeling: Revision of the Nutrition and Supplement Facts Labels. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. American Academy of Pediatrics Committee on Fetus and Newborn. The only clinically significant indicator of vitamin K status is prothrombin time (the time it takes for blood to clot), and ordinary changes in vitamin K intakes have rarely been shown to alter prothrombin time [5]. CFE – Code of Federal Regulations Title 21, Sec. �-n����g�JcC%�+-�ҫLH=݂"-�֗-xpQ��0d]����&�X��)ja�37�&�(�2`�[�e'�)b1C�H#U��|DŒ�0y��j �Of�2��d�M������=������@0���$ͼXC8ܕ�N �j�Q����L.~{���e)>�����4?3IJ h�uk� e�A��;Y��i���>�=� S However, among the 295 participants who adhered to the supplementation protocol, those in the treatment group had significantly less coronary artery calcification progression than those in the control group. Washington, DC: National Academy Press; 2001. Vitamin K. In: Coates PM, Betz JM, Blackman MR, et al., eds. [, Pichler E, Pichler L. The neonatal coagulation system and the vitamin K deficiency bleeding - a mini review. Join the ODS Email List. Food Labeling: Revision of the Nutrition and Supplement Facts Labels and Serving Sizes of Foods That Can Reasonably Be Consumed at One Eating Occasion; Dual-Column Labeling; Updating, Modifying, and Establishing Certain Reference Amounts Customarily Consumed; Serving Size for Breath Mints; and Technical Amendments; Proposed Extension of Compliance Dates. J Am Coll Nutr 2014;33:94-102. Vitamin K is most commonly used for blood clotting problems or for reversing the blood thinning effects of warfarin. The AIs for infants are based on the calculated mean vitamin K intake of healthy breastfed infants and the assumption that infants receive prophylactic vitamin K at birth as recommended by American and Canadian pediatric societies [3]. Kidney Int2013;83:782-4. U.S. Department of Agriculture USDHHS. stream Based on these findings, the authors did not make any clinical recommendations, and they called for larger studies in other populations. 6 Intravenous vitamin K can lower the INR more quickly than oral vitamin K, but at 24 hours, intravenous and oral vitamin K produce similar … [, Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, et al. (Refer to the guideline entitled ‘Dissemination of Patient Information in Maternity’; … In the circulation, vitamin K is carried mainly in lipoproteins [2]. Clinically significant vitamin K deficiency in adults is very rare and is usually limited to people with malabsorption disorders or those taking drugs that interfere with vitamin K metabolism [3,7]. It is also available in dietary supplements containing only vitamin K or vitamin K combined with a few other nutrients, frequently calcium, magnesium, and/or vitamin D. These supplements tend to have a wider range of vitamin K doses than multivitamin/mineral supplements, with some providing 4,050 mcg (5,063% of the DV) or another very high amount [20]. Vitamin K status can also be low in patients who have undergone bariatric surgery, although clinical signs may not be present [28]. Parenteral administration of vitamin K replacements (including AquaMEPHYTON) may cause cutaneous reactions. Antibiotics can destroy vitamin K-producing bacteria in the gut, potentially decreasing vitamin K status. Blood 2007;109:3279-83. According to the updated CHEST guidelines, vitamin K should be administered based on INR level and degree of … �$\��3�ň���txI"$���y4d�v�Z ��F�z]��O���98�$�P��x%�zL��9,E�8�Na*#b�����S�o�T��y���4�ƾ���r��� b�$!v�ԙiԗŬ]� The absorption rate of phylloquinone in its free form is approximately 80%, but its absorption rate from foods is significantly lower [2]. The effect of vitamin K intakes and status on bone health and osteoporosis has been a focus of scientific research. [, Shea MK, O'Donnell CJ, Hoffmann U, Dallal GE, Dawson-Hughes B, Ordovas JM, et al. 7 0 obj �ԯH��\#A&���6��6=�3��2h�� �8�e� �� ���Ϝz��Bd�G��k����"=*l�L��I���u�V�j� H�Mr�����=���5�L��4�z��ljPMV���%&����.�H�I ��Yn�N�Zt�)K�|�u�P-�(�_��RS*�gJBΧ�o�4��E�����jp�����އ�n*��qѥ6jZ�]�i�p���o2�vD��twtuF�U�$.�~ԋz At this time, the role of the different forms of vitamin K on arterial calcification and the risk of coronary heart disease is unclear, but it continues to be an active area of research in the general population and in patients with chronic kidney disease [5,9,46]. ��d�iT�� Ĩ��DL���Wp�~���j�U2@��`V#!�r8��T�9Ƽі Washington, DC: U.S. Government Printing Office; 2010. In adults, deficiencies can occur in people using antibiotics for prolonged periods, possibly due to the destruction of the intestinal bacteria that produce vitamin K. In addition, certain medications can have an adverse effect on vitamin K levels. Although the ACCP recommendations do not endorse the oral (PO) administration of phytonadione, a few reports have found this route to be effective. For a reader-friendly overview of Vitamin K, see our consumer fact sheet on Vitamin K. "Vitamin K," the generic name for a family of compounds with a common chemical structure of 2-methyl-1,4-naphthoquinone, is a fat-soluble vitamin that is naturally present in some foods and is available as a dietary supplement [1]. Foods, fortificants, and supplements: Where do Americans get their nutrients? <�g) /Keywords (�@x�U$���VS�,T^o�r &�6y�3�chY��OO�\)也]0RT@�9�\\M�����5�K�X����+�\(U*F��) /CreationDate (�>�r�����0F'�'U�=)>> In adults aged 20 and older, the average daily vitamin K intake from foods is 122 mcg for women and 138 mcg for men. However, there were no significant differences in bone mineral density of the lumbar spine or proximal femur among any of the treatment groups. MK-4, MK-7, and MK-9 are the most well-studied menaquinones. Vitamin K deficiency can occur during the first few weeks of infancy due to low placental transfer of phylloquinone, low clotting factor levels, and low vitamin K content of breast milk [7]. Furthermore, among those with coronary artery calcification at baseline, phylloquinone treatment reduced calcification progression by 6% compared to the control group. [, Schurgers LJ, Vermeer C. Determination of phylloquinone and menaquinones in food. For more information about building a healthy diet, refer to the Dietary Guidelines for Americans and the U.S. Department of Agriculture's MyPlate. At 24 hours, the effects of 5 mg of oral vitamin K on INR is roughly equal to 1 mg of intravenous vitamin K.2 Generally use doses of 2.5 to 5 mg. 2008;158:385-95. NIH consensus statement 2000;17:1-45. This rapid metabolism accounts for vitamin K's relatively low blood levels and tissue stores compared to those of the other fat-soluble vitamins [11]. [, Rejnmark L, Vestergaard P, Charles P, Hermann AP, Brot C, Eiken P, et al. All values in this table are for phylloquinone content, except when otherwise indicated, because food composition data for menaquinones are limited [1]. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. Several food sources of vitamin K are listed in Table 2. 4 0 obj Newborn Infection Control & Prevention Guidelines; ... which is organized by system for easy access to the clinical team. Scientific opinion on the substantiation of health claims related to vitamin K and maintenance of bone pursuant to Article 13(1) of Regulation (EC) No 1924/2006. 2 0 obj Multivitamin/mineral supplement contribution to micronutrient intakes in the United States, 2007-2010. These individuals might need monitoring of vitamin K status and, in some cases, vitamin K supplementation. Compared to the other fat-soluble vitamins, very small amounts of vitamin K circulate in the blood. VKDB is associated with bleeding in the umbilicus, gastrointestinal tract, skin, nose, or other sites [7,26,27]. [, Sadowski JA, Hood SJ, Dallal GE, Garry PJ. 6 0 obj Moreover, reports of vitamin K deficiency in adults are very rare [3,7]. Some, but not all, studies also link higher vitamin K intakes with higher bone mineral density and/or lower hip fracture incidence [31-36]. Time of onset ranged from 1 day to a year after parenteral administration. Get the latest research information from NIH: https://www.nih.gov/coronavirus, Have a question? administration of vitamin K with the patient in full and give the vitamin K patient information leaflet; ensuring that the midwife has documented the discussion and signed the relevant section in the antenatal handheld patient’s healthcare records. The significance of these findings is unclear because the AI is only an estimate of need, especially for vitamins (like vitamin K) that are also synthesized endogenously. Pharmacotherapy 2002;22:814-22. These values, which vary by age and gender, include: Insufficient data were available to establish an EAR for vitamin K, so the FNB established AIs for all ages that are based on vitamin K intakes in healthy population groups [3]. about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. [. Vitamin K transport across the placenta is poor, increasing the risk of vitamin K deficiency in newborn babies [3]. [. Other randomized clinical trials since the 2006 review by Cockayne et al. The following information includes only the average doses of these medicines. Correction of Vitamin K antagonist- impairment of hemostasis is reached at the latest 30 min after the injection and will persist for ~ 6-8 hrs. IQ��j��M@���O�V�5� )����鼥�S�" �s��C2)^��L�^L�Y�,ݑ�^yv��]y�2:T�����Q��W�2��Ob�7x��܇*������k�vR���=C��}VNs����F��ע�Q3h�j��ie��w���p���2���)$+v�v�9���ijv���;&Ic�V�.������kQrO��P�X:7�a���B�0D��4�,Hn��E=! Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals. Guidance for Industry: A Food Labeling Guide. FDA does not require food labels to list vitamin K content unless vitamin K has been added to the food. endobj Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet. Adv Nutr 2013;4:463-73. Appendix B: Phytonadione (Vitamin K) Dosing Guidelines Authorized prescriber order is required for holding of warfarin dosing or administration of phytonadione. In healthy people, fasting concentrations of phylloquinone in plasma have been reported to range from 0.29 to 2.64 nmol/L [12]. endobj The AAP has supported this routine hospital procedure since 1961 to prevent unexpected bleeding in the first week of life. [, Beulens JW, Bots ML, Atsma F, Bartelink ML, Prokop M, Geleijnse JM, et al. From there, vitamin K is incorporated into chylomicrons, secreted into the lymphatic capillaries, transported to the liver, and repackaged into very low-density lipoproteins [2,10]. Phylloquinone intake had no effect on any outcome. For this reason, individuals who are taking these anticoagulants need to maintain consistent vitamin K intakes. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to admini… In most cases, vitamin K status is not routinely assessed, except in individuals who take anticoagulants or have bleeding disorders. Booth SL, Broe KE, Gagnon DR, Cupples LA, et al Determination phylloquinone. As vitamin K contents of meat, dairy foods, such as cheese, also contain menaquinones and.... The AAP has supported this routine hospital procedure since 1961 to prevent unexpected bleeding in the gut, decreasing... Structure is similar to warfarin and other coumarin-like anticoagulants, which function as vitamin K in the United States 2007-2010. Americans notes that `` Nutritional needs should be met primarily from foods nucleus... 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Lippincott Williams & Wilkins ; 2014:305-16 foods [ 1,4 ] well absorbed, but MK-7 a. 12 showed that supplementation with either phytonadione or MK-4 improved bone mineral density of the lumbar spine or femur. Have an adverse effect on bone loss in elderly men and women on. And progression of coronary artery calcification between the treatment groups are present in bone and may be in! Coronary artery calcification at baseline, phylloquinone treatment reduced calcification progression by 6 % compared the... R, Leung J, Still C, Peterson JW, Bots ML, Prokop,! Arterial calcification or coronary heart disease risk Fetus and Newborn Comparative pharmacokinetics of vitamin intake... About building a healthy diet, refer to the dietary Guidelines for Americans notes that `` Nutritional should! Who are taking these medications, especially green vitamin k administration guidelines vegetables and is the term.