Vitamin k can be used in parenteral nutrition as maintenance requirement and used for several indications, some are based on the condition and some are INR based doses.

Reversal of vitamin K antagonists (eg, warfarin):

1. No bleeding, rapid reversal needed, patient will require further oral anticoagulant therapy: SubQ, IV: 0.5 to 2 mg.
2. No bleeding, rapid reversal needed, patient will not require further oral anticoagulant therapy: SubQ, IV: 2 to 5 mg.
3. Significant bleeding, not life-threatening: SubQ, IV: 0.5 to 2 mg; Note: Use in combination with fresh frozen plasma.
4. Significant bleeding, life-threatening: SubQ, IV: 5 mg; Note: Consider use with prothrombin complex concentrate containing factors II, VII, IX, X.

Vitamin K deficiency, prevention, and supplementation (disease-specific): Limited data available:

• Biliary atresia (Shneider 2012): Note: Dose and route are determined by INR value: Infants 1 to 6 months:

1. INR >1.2 to 1.5: 2.5 mg once daily orally.
2. INR >1.5 to 1.8: Initial: 2 to 5 mg IM once followed by 2.5 mg once daily orally.
3. INR >1.8: Initial: 2 to 5 mg IM once followed by 5 mg once daily orally.

• Cholestasis: Infants, Children, and Adolescents: Oral: 2.4 to 15 mg/day (Sathe 2010).
• Cystic fibrosis: Infants, Children, and Adolescents: Oral: 0.3 to 0.5 mg/day (Borowitz 2002; Sathe 2010).
• Liver disease: Infants, Children, and Adolescents: Oral: 2.5 to 5 mg/day (Nightingale 2009; Sathe 2010).