Patient's question:
Some blood vessels, sometimes one, sometimes two. Three months and 11 days after birth. Detected red blood cells and white blood cells in the stool. Speculated to be a lack of vitamin K. Past treatment and effectiveness: The town hospital prescribed Amoxicillin granules and vitamin K medication.Doctor's answer:
K is a general term for 2-methyl-1,4-naphthoquinone derivatives, which possess coagulation activity. In their natural form, they are substituted at the 3rd position with an alkyl side chain. Vitamin K1 (phylloquinone) has a phylloquinone side chain, which is the only homologue of vitamin K found in plants. Vitamin K2 refers to a group of 2-methyl-1,4-naphthoquinone homologues, where the 3rd position is replaced by an isoprenyl side chain containing 4 to 13 isoprenyl units. These are called menaquinones; the suffix (-n) indicates the number of isoprenyl units in this side chain. Menaquinones are produced by bacteria in the gut and are essential for supplying vitamin K. Vitamin K is essential because the 1,4-naphthoquinone core cannot be synthesized in the body. The daily requirement for vitamin K is approximately 1 μg/kg. A deficiency in vitamin K leads to hypoprothrombinemia, and an increase in the concentration of other vitamin K antagonistic clotting factors, manifesting as coagulation defects and bruising.Recommendation: Phylloquinone is the active ingredient in the preparation and is marketed as vitamin K1. It can be used to treat hypoprothrombinemia, especially that caused by anticoagulant derivatives of coumarins or indandiones. Sodium menadione disulfide is ineffective against these antagonists because its conversion to vitamin K2 is very low (1%). If possible, vitamin K1 should be administered subcutaneously or intramuscularly. The usual adult dose is 10 mg intramuscularly. In emergencies, 10–20 mg of vitamin K1 can be administered intravenously, dissolved in 5% glucose or 0.9% sodium chloride solution, at a rate not exceeding 1 mg per minute (extremely rarely, even when vitamin K1 is appropriately dissolved and administered slowly, severe hypersensitivity-like reactions may still occur, including shock and cessation of heartbeat and breathing). If the PT does not decrease satisfactorily, the same dose may be repeated every 6–8 hours; usually, it takes effect within 1–2 hours. In most cases, this treatment is effective within 3–6 hours. Patients taking anticoagulants can take 15–20 mg of vitamin K1 orally to non-emergently suppress hypoprothrombinemia, with efficacy typically becoming apparent within 6–10 hours.