Abstract
Two cats with intestinal malabsorption developed a hemorrhagic diathesis. Although unsubstantiated, the probable cause of bleeding was a chronic malabsorption of fat and the fat‐soluble vitamin K. When treated_with vitamin Ki per os, one cat's clotting times were only partially corrected. Since vitamin K, is actively absorbed in the proximal small intestine, the incomplete response of this case to orally administered vitamin K, was predictable. The infrequent occurrence of bleeding in animals with malabsorption is, in part, attributable to the ileal and colonic absorption of bacterially derived vitamin K2. For this reason, nonspecific use of antibiotics in these animals is contraindicated. Since long‐chain, polyunsaturated fats impair vitamin K absorption, dietary fat given to animals with malasorption should be restricted to medium‐ and short‐chain, saturated fats. Vitamin K should be administered subcutaneously to these animals if prolonged clotting times or active bleeding is present, and routinely prior to surgery. Oral supplementation with vitamin K3, which is absorbed in the colon and less lipid soluble than vitamin Ki, should be given to animals with malabsorption that are maintained as outpatients. Adequate dosage levels of vitamin K3, however, are yet to be established for the cat, and dose‐dependent hemolytic anemia is a probable toxic manifestation.
References
- 1. Gallop PM, Lian JB, Hauschka PV. Carboxylated calcium‐binding proteins and vitamin K. N Engl J Med 1980; 302:1460–1466. [DOI] [PubMed] [Google Scholar]
- 2. Hollander D., Rim E., Muralidhara KS. Vitamin K. intestinal absorption in vivo: influence of luminal contents on transport. Am J Physiol 1977; 232: 74. [DOI] [PubMed] [Google Scholar]
- 3. Ramotar K., Conly JM, Chubb H., et al. Production of menaquinones by intestinal anaerobes. J Infect Dis 1984; 150:213–218. [DOI] [PubMed] [Google Scholar]
- 4. Hollander D., Rim E., Ruble PE. Vitamin K2 colonic and ileal in vivo absorption: bile, fatty acids, and pH effects on transport. Am J Physiol 1977; 233:E124–E129. [DOI] [PubMed] [Google Scholar]
- 5. Hollander D., Truscott TC. Mechanism and site of vitamin K3 small intestinal transport. Am J Physiol 1974;226:1516–1522. [DOI] [PubMed] [Google Scholar]
- 6. Hollander D., Truscott TC. Colonic absorption of vitamin K3 . J Lab Clin Med 1974; 83:648–656. [PubMed] [Google Scholar]
- 7. Shearer MJ, McBurney A., Barkhan P. Studies on the absorption and metabolism of phylloquinone (vitamin K) in man. Vitam Horm 1974;32:513–542. [DOI] [PubMed] [Google Scholar]
- 8. Jaques LB, Millar GJ, Spinks, JWT. Metabolism of K‐vitamins. Schweiz Med Wochenschr 1954; 29:792–796. [PubMed] [Google Scholar]
- 9. Griminger P.: Biological activity of the various vitamin K forms Vitam Horm 1966; 24: 605–618. [DOI] [PubMed] [Google Scholar]
- 10. Hemker HC, Veltkamp JJ, Hensen A., et al. Nature of prothrombin biosynthesis: preprothrombinanemia in vitamin K deficiency. Nature 1963; 200:589–590. [DOI] [PubMed] [Google Scholar]
- 11. Dutta SK, Bustin MP, Russell RM, et al. Deficiency of fat‐soluble vitamins in treated patients with pancreatic insufficiency. Ann Intern Med 1982; 97:549–552. [DOI] [PubMed] [Google Scholar]
- 12. Deutsch E. Vitamin K in medical practice: adults. Vitam Horm 1966; 24:665–680. [DOI] [PubMed] [Google Scholar]
- 13. Evans WB, Wollaeger EE. Incidence and severity of nutritional deficiency states in chronic exocrine pancreatic insufficiency: comparison with non‐tropical sprue. American Journal of Digestive Diseases 1966; 11:594–606. [DOI] [PubMed] [Google Scholar]
- 14. Kark R., Souter AW, Hayward JC. A haemorrhagic diathesis in idiopathic steatorrhoea: observations on its association with vitamin K deficiency. Q J Med 1940; 9:247–261. [Google Scholar]
- 15. Moore MJ, Stickland WH, Prichard RW. Sprue with bleeding from hypoprothrombinemia. Arch Intern Med 1956; 97:814–816. [DOI] [PubMed] [Google Scholar]
- 16. Hawkins EC, Merick SM, Washabau RJ, et al. Digestion of bentiromide and absorption of xylose in healthy cats and absorption of xylose in cats with infiltrative intestinal disease. Am J Vet Res 1986;47:567–569. [PubMed] [Google Scholar]
- 17. Green RA, Roudebush P., Barton CL. Laboratory evaluation of coagulopathies due to vitamin K antagonism in the dog: three case reports. J Am Anim Hosp Assoc 1979; 15:691–697. [Google Scholar]
- 18. Mangurten HH, Honig GR. Hemorrhagic disease due to vitamin K deficiency in a premature infant: a syndrome which may resemble disseminated intravascular coagulation (DIC). Clin Pediatr (Phila) 1973; 12:372–375. [PubMed] [Google Scholar]
- 19. Blanchard RA, Furie BC, Jorgensen M., et al. Acquired vitamin K dependent carboxylation deficiency in liver disease. N Engl J Med 1981;305:242–248. [DOI] [PubMed] [Google Scholar]
- 20. Liebman HA, Furie BC, Blanchard RA, et al. Des‐7‐carboxy (abnormal) prothrombin: a new serum marker of primary hepatocellular carcinoma. N Engl J Med 1984; 310:1427–1431. [DOI] [PubMed] [Google Scholar]
- 21. Krasinski SD, Russell RM, Furie BC, et al. The prevalence of vitamin K deficiency in chronic gastrointestinal disorders. Am J Clin Nutr 1985; 41:639–643. [DOI] [PubMed] [Google Scholar]
- 22. Braun W., Beyreib K., Mahnke P‐R, et al. Liver changes in malabsorption syndrome. Monatsschr Kinderheilkd 1980; 128:311–314. [PubMed] [Google Scholar]
- 23. Tarns TR: Chronic feline inflammatory bowel disorders Part I. Idiopathic inflammatory bowel disease. Compendium on Continuing Education for the Practicing Veterinarian 1986; 8: 371–376. [Google Scholar]
- 24. Willard MD, Dalley JB, Trapp AL. Lymphocytic‐plasmacytic enteritis in a cat. J Am Vet Med Assoc 1985; 186:181–182. [PubMed] [Google Scholar]
- 25. Gustafson BE, Daft FS, McDaniel EG, et al. Effects of vitamin K‐active compounds and intestinal microorganisms in vitamin K‐deficient germ‐free rats. J Nutr 1962; 78:461–468. [DOI] [PubMed] [Google Scholar]
- 26. Conly JM, Ramotar K., Chubb H., et al. Hypoprothrombinemia in febrile, neutropenic patients with cancer: association with antimicrobial suppression of intestinal microflora. J Infect Dis 1984; 150:202–212. [DOI] [PubMed] [Google Scholar]
- 27. Pineo GF, Gallus AS, Hirsh J. Unexpected vitamin K deficiency in hospitalized patients. Can Med Assoc J 1973; 109:880–883. [PMC free article] [PubMed] [Google Scholar]
- 28. Hollander D.: Intestinal absorption of vitamins A, E, D and K. J Lab Clin Med 1981; 97: 449–462. [PubMed] [Google Scholar]
- 29. Weber F. Absorption mechanisms of fat‐soluble vitamins and the effect of other food constituents. Prog Clin Biol Res 1981; 77:119–135. [PubMed] [Google Scholar]
- 30. Vest M. Vitamin K in medical practice: pediatrics. Vitam Horm 1966; 24:649–663. [DOI] [PubMed] [Google Scholar]
- 31. Fernandez FR, Davies AP, Teachout EJ, et al. Vitamin K‐induced Heinz body formation in dogs. J Am Anim Hosp Assoc 1984; 20:711–720. [Google Scholar]
- 32. Winterbourn CC, French JK, Claridge RFC: The reaction of menadione with haemoglobin. Biochem J 1979; 179: 665–673. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33. Cullinson RF. Acetaminophen toxicosis in small animals: clinical signs, mode of action, and treatment. Compendium on Continuing Education for the Practicing Veterinarian 1984; 6:315–321. [Google Scholar]