Vitamin K Deficiency in the Setting of Blenderized Tube Feeding Regimen in a Teenager: A Case Report.

Vitamin K acts a cofactor for the gamma-carboxylation of several proteins in the coagulation cascade. The clinical spectrum of vitamin K deficiency (VKD) can be asymptomatic to a significant bleeding. VKD is classically seen in newborns. However, this can manifest later in patients with risks such as sub-optimal nutrition, fat malabsorption, medications including antibiotics. A 17-year-old male with spinal muscular atrophy (SMA) Type 1, tracheostomy with ventilator dependent, gastrostomy tube feeding was seen by the gastroenterologist following treatment for small intestinal bacterial overgrowth (SIBO). Investigations showed coagulopathy following which he was transferred to the Pediatric ICU. Labs revealed prothrombin time (PT) 114 s [Normal 9.4-12.5 s], INR (International normalized ratio) 12.6 [Normal < 1.1] and partial thromboplastin time (PTT) 90 s [Normal 25.1-36.5 s]. Mixing studies and coagulation assays were consistent with VKD (low Factor VII and Factor IX with normal Factor V). His home blenderized feeding regimen met the caloric requirement but not the adequate intake (AI) values for vitamin K and other minerals. He received intravenous vitamin K (phytonadione) for five consecutive days with resolution of the coagulopathy (PT 13.2 s, PTT 37.1 s, INR 1.2). The patient was discharged on enteral vitamin K and additional supplements following dietary review by a nutritionist. Clinicians should be cognizant of VKD in patients on blenderized tube feeds which may not meet the adequate intake (AI) goals. In patients who are not receiving nutritionally complete formulas or receiving inadequate volumes, it is important to monitor macro and micronutrients.

Health seeking behaviour of parents for children with pneumonia.

INTRODUCTION: Health knowledge seeking behaviour is increasing throughout the world. Our study is trying to find out this attitude among parents of children with pneumonia. METHODS: A retrospective study was conducted to analyse all admitted children with pneumonia at Dhulikhel Hospital from September 1, 2006 to August 31, 2007. "Duration of illness at home prior to hospital presentation" was taken as the index of health seeking behaviour of the parents. RESULTS: The mean duration of illness prior to hospital presentation for males and females were 4.40 days and 4.16 days respectively (P > 0.05). Children who had been hospitalised in the past had a mean of 4.93 days; those never hospitalised before had 4.08 days (P > 0.05). Children from Bhaktapur and Kathmandu were brought to the hospital the earliest. Younger children were brought to the hospital sooner; children less than five years were brought earlier, particularly infants. CONCLUSIONS: Health seeking behaviour of the parents is affected by age of the children and geographical location. However, previous hospitalisation of the child and their gender do not affect health seeking behaviour of the parents.