Question:
An infant has cholestasis. What is the recommended vitamin K dose in this case?
An infant has cholestasis. What is the recommended vitamin K dose in this case?
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Fat-Soluble Vitamin Doses in Cholestasis:
$\bullet$ Vitamin A: $5,000\text{--}10,000\text{ IU/day}$
$\bullet$ Vitamin D: $1,200\text{--}5,000\text{ IU/day}$ (or calcidiol $3\text{--}5\text{ }\mu\text{g/kg/day}$)
$\bullet$ Vitamin E (TPGS): $15\text{--}25\text{ IU/kg/day}$
$\bullet$ Vitamin K: $2.5\text{--}5\text{ mg/day}$ orally (or $2.5\text{--}5\text{ mg}$ IM every $2\text{--}4$ weeks).
$\bullet$ Vitamin A: $5,000\text{--}10,000\text{ IU/day}$
$\bullet$ Vitamin D: $1,200\text{--}5,000\text{ IU/day}$ (or calcidiol $3\text{--}5\text{ }\mu\text{g/kg/day}$)
$\bullet$ Vitamin E (TPGS): $15\text{--}25\text{ IU/kg/day}$
$\bullet$ Vitamin K: $2.5\text{--}5\text{ mg/day}$ orally (or $2.5\text{--}5\text{ mg}$ IM every $2\text{--}4$ weeks).
Updated On: Sep 3, 2026
- Daily 2.5–5 mg
- Alternate days 2.5–5 mg
- Weekly
- Stat dose
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The Correct Option is A
Solution and Explanation
Concept:
Neonatal cholestasis impairs the normal delivery of bile salts into the duodenal lumen, disrupting micellar solubilization and absorption of fat-soluble vitamins (A, D, E, and K).
Vitamin K deficiency rapidly impairs hepatic gamma-carboxylation of coagulation factors II, VII, IX, and X, predisposing the infant to coagulopathy and life-threatening intracranial hemorrhage.
Explanation:
• In chronic cholestatic liver disease, intestinal absorption of dietary fat-soluble vitamins is profoundly reduced.
• Standard pediatric gastroenterology and hepatology consensus guidelines (ESPGHAN/NASPGHAN) mandate regular oral supplementation with fat-soluble vitamins for all cholestatic infants.
• Because of poor intestinal absorption, standard physiological replacement doses are inadequate; high-dose oral water-soluble micellar preparations are required.
• The recommended routine maintenance dosage for Vitamin K in pediatric cholestasis is $2.5\text{ to 5\text{ mg administered orally daily}$}, or $5\text{ mg}$ twice weekly, or periodic parenteral doses ($2.5\text{--}5\text{ mg}$ IM/SC every $1\text{--}4\text{ weeks}$) if oral absorption is severely compromised.
• Daily oral supplementation ensures consistent maintenance of prothrombin complex activity and prevents coagulopathy during periods of poor dietary intake.
Final Answer:
The recommended oral vitamin K maintenance supplementation in an infant with cholestasis is 2.5–5 mg daily.
Neonatal cholestasis impairs the normal delivery of bile salts into the duodenal lumen, disrupting micellar solubilization and absorption of fat-soluble vitamins (A, D, E, and K).
Vitamin K deficiency rapidly impairs hepatic gamma-carboxylation of coagulation factors II, VII, IX, and X, predisposing the infant to coagulopathy and life-threatening intracranial hemorrhage.
Explanation:
• In chronic cholestatic liver disease, intestinal absorption of dietary fat-soluble vitamins is profoundly reduced.
• Standard pediatric gastroenterology and hepatology consensus guidelines (ESPGHAN/NASPGHAN) mandate regular oral supplementation with fat-soluble vitamins for all cholestatic infants.
• Because of poor intestinal absorption, standard physiological replacement doses are inadequate; high-dose oral water-soluble micellar preparations are required.
• The recommended routine maintenance dosage for Vitamin K in pediatric cholestasis is $2.5\text{ to 5\text{ mg administered orally daily}$}, or $5\text{ mg}$ twice weekly, or periodic parenteral doses ($2.5\text{--}5\text{ mg}$ IM/SC every $1\text{--}4\text{ weeks}$) if oral absorption is severely compromised.
• Daily oral supplementation ensures consistent maintenance of prothrombin complex activity and prevents coagulopathy during periods of poor dietary intake.
Final Answer:
The recommended oral vitamin K maintenance supplementation in an infant with cholestasis is 2.5–5 mg daily.
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