2025 – PAGE 220 – VITAMIN AND NUTRITIONAL DISORDERS

VITAMIN K DEFICIENCY (AKA PHYTONADIONE DEFICIENCY)

Vitamin K deficiency (Phytonadione deficiency) can result in HEMORRHAGIC DISEASE OF THE NEWBORN due to a coagulopathy. Vitamin K is needed for use with coagulation factors 2, 7, 9, and 10. This is especially a concern in babies because there is a lack of normal gut flora needed to make the Vitamin K. Deficiency is also more common in breastfed babies that did not receive Vitamin K at birth (watch out for a home birth). Look for a bleeding circumcision site or umbilical cord site.

Early Vitamin K deficiency usually occurs within the first week of life.

Late Vitamin K deficiency can occur any time between two weeks and three months! Look for a breastfed baby on antibiotics who has diarrhea (decreased gut flora to make Vitamin K due to antibiotic use, and decreased absorption due to diarrhea).

• TREATMENT: For bleeding patients, give Vitamin K + Fresh Frozen Plasma. (FFP contains plenty of functional Vitamin K dependent coagulation factors.)
• PEARL: Oral Vitamin K at birth does NOT prevent HEMORRHAGIC DISEASE OF THE NEWBORN.

VITAMIN E DEFICIENCY (AKA TOCOPHEROL DEFICIENCY)

Vitamin E deficiency (Tocopherol deficiency) can result in hemolytic anemia, impaired reflexes, jaundice, neurologic problems, or peripheral edema.

• PEARL: When seen, it is almost always in association with a patient getting TPN.
• MNEMONICS:
  • TocopHERol: Hemolysis, Edema and Retarded reflexes
  • Vitamin EE deficiency leads to a knEE reflex deficiency.

VITAMIN D (ERGOCALCIFEROL, CHOLECALCIFEROL) EXCESS

An excess of Vitamin D (AKA ergocalciferol or cholecalciferol) results in a hypercalcemia-induced diuresis. Look for hypERcalcemia, hypERphosphatemia, polyuria, and polydipsia. Patients may also have nausea, vomiting, nephrolithiasis, and an elevated BUN and/or creatinine. Treat with IV fluids and furosemide (which helps remove the excess calcium).

VITAMIN D DEFICIENCY

A deficiency of Vitamin D (AKA ergocalciferol or cholecalciferol) can result in RICKETS.

MNEMONIC: Vitamin D gets absorbed in the gut and goes to the LIVER (one organ). It then gets activated in the KIDNEYS (two organs). One organ, one number (25). Two organs, two numbers (1,25).

PEARL: When evaluating for Vitamin D Deficiency, measure 25-Vitamin D if you’re concerned about a GI issue (liver or bowel dysfunction) and 1,25 if you’re concerned about a renal problem.

(DOUBLE TAKE) RICKETS

Rickets is a disorder with multiple possible causes that lead to defective mineralization of bones before epiphyseal closure due to a deficiency or impaired metabolism of vitamin D, phosphorus, and/or calcium. The defective mineralization can then potentially lead to fractures and deformities. Findings of Rickets may include widening of wrist and ankle physes (growth plates), bowed legs, pain, decreased growth rate, anorexia, enlarged costochondral junctions (rachitic rosary), pigeon chest, delayed suture/fontanelle closure, frontal bossing (thick skull), or bad tooth enamel. There is no singular lab pattern for Rickets. It can be due to Vitamin D deficiency secondary to one of multiple different disorders, and you MUST learn the lab patterns associated with the different disorders: