Pettei M J, Israel D, Levine J
Division of Gastroenterology and Nutrition, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
JPEN J Parenter Enteral Nutr. 1993 Sep-Oct;17(5):465-7. doi: 10.1177/0148607193017005465.
The only multivitamin preparation for total parenteral nutrition currently available in the United States that contains vitamin K is the pediatric formulation MVI-Pediatric. The recommended dose provides 200 micrograms of vitamin K1 per day to term infants and children up to 11 years old. This dose is well above the recommended dietary allowance of approximately 1 microgram/kg per day, but the losses of vitamin K during administration are unknown. We evaluated the stability of vitamin K1 in a standard total parenteral nutrition infusion and found that an average 72.7 +/- 4.9% of the original vitamin K1 was present after 24 hours. By using high-performance liquid chromatography with electrochemical reduction and fluorescence detection, we obtained the serum vitamin K1 concentrations in 11 pediatric patients receiving total parenteral nutrition with MVI-Pediatric (Rorer Pharmaceuticals, Fort Washington, PA) supplementation and in control children. The serum vitamin K1 concentration (19.3 +/- 12.2 ng/mL) in patients receiving MVI-Pediatric is significantly higher than that in control children 1.9 +/- 1.5 ng/mL (p < .001). Current practice results in excessive levels of vitamin K in pediatric patients.
美国目前唯一可用于全胃肠外营养的含维生素K的多种维生素制剂是儿科配方的MVI-儿科。推荐剂量为足月婴儿及11岁以下儿童每天提供200微克维生素K1。该剂量远高于约1微克/千克/天的推荐膳食摄入量，但给药过程中维生素K的损失情况未知。我们评估了标准全胃肠外营养输液中维生素K1的稳定性，发现24小时后平均仍有72.7±4.9%的初始维生素K1存在。通过使用带电化学还原和荧光检测的高效液相色谱法，我们测定了11名接受补充MVI-儿科（罗瑞制药公司，宾夕法尼亚州华盛顿堡）的全胃肠外营养的儿科患者以及对照儿童的血清维生素K1浓度。接受MVI-儿科治疗的患者血清维生素K1浓度为19.3±12.2纳克/毫升，显著高于对照儿童的1.9±1.5纳克/毫升（p<0.001）。目前的做法导致儿科患者体内维生素K水平过高。
