Coagulopathy by vitamin K deficiency: Clinical pitfall in a case with cerebral palsy under long-term enteral nutrition

Mariko Yada, Tomoyo Itonaga, Saori Oguri, Yuka Kimura, Kenji Ihara
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Abstract

Background

Vitamin K deficiency is common in patients with neurological impairment under long-term enteral nutrition; however, reports of vitamin K deficiency in pediatric patients under long-term enteral nutrition remain limited, and critical conditions potentially leading to coagulopathy have not been sufficiently acknowledged by healthcare professionals.

Case presentation

We report the case of a seven-year-old girl with severe cerebral palsy who had received enteral nutrition via a nasoduodenal tube due to recurrent acute pancreatitis that had persisted for six months, and who had received an elemental diet for seven weeks prior to her presentation. After two days of cefmetazole treatment for urinary tract infection, abnormal coagulation findings, including a prolonged prothrombin time, activated partial thromboplastin time, and elevated levels of protein induced by vitamin K absence or antagonist-II, were detected. The patient's hypoprothrombinemia improved after the intravenous administration of vitamin K and switching antibiotics. From a retrospective point of view, her intake of vitamin K over the past six months was below the recommended amount for her age.

Conclusions

Long-term enteral nutrition is associated with an increased risk of coagulopathy due to vitamin K deficiency, which can be precipitated by prolonged use of antibacterial agents. When long-term enteral nutrition is given to patients with severe motor or intellectual disabilities, caution should be exercised when using antibiotics with NMTT side chains.
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维生素 K 缺乏引起的凝血病:长期肠内营养脑瘫病例中的临床陷阱
背景在长期接受肠内营养的神经系统受损患者中,维生素 K 缺乏症很常见;然而,关于长期接受肠内营养的儿科患者维生素 K 缺乏症的报道仍然有限,可能导致凝血病的危急情况尚未得到医护人员的充分认识。病例介绍我们报告了一例患有重度脑瘫的七岁女孩的病例,她因反复发作的急性胰腺炎已持续六个月而通过鼻十二指肠插管接受肠内营养,并在就诊前接受了七周的元素饮食。因尿路感染接受头孢美唑治疗两天后,发现凝血功能异常,包括凝血酶原时间延长、活化部分凝血活酶时间延长以及维生素 K 缺乏或拮抗剂-II 引起的蛋白质水平升高。在静脉注射维生素 K 和更换抗生素后,患者的低凝血酶原血症得到了改善。结论长期肠内营养与维生素 K 缺乏导致的凝血病风险增加有关,而长期使用抗菌药可能会诱发凝血病。在为严重运动障碍或智力障碍患者提供长期肠内营养时,应谨慎使用具有 NMTT 侧链的抗生素。
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