When clotting falters: vitamin K deficiency in short gut syndrome case report

The loss of a portion of the small intestine, whether from surgical resections and/or congenital anatomical abnormalities, can result in short gut syndrome. The syndrome can lead to malnutrition and deficiencies in vitamins and minerals, including a vitamin K deficiency caused by impaired fat absorption due to ileum resection. Vitamin K deficiency presenting as severe coagulopathy in a patient with short gut syndrome can lead to devastating consequences if not properly managed in the emergency department. Our case report is unique in presenting a pediatric patient with short gut syndrome who developed a coagulopathy secondary to a vitamin K deficiency.

A 13-year-old male with a complex medical history, including short gut syndrome due to multiple intestinal resections, presented to the emergency department with altered mental status and a report of gastrointestinal bleeding. On arrival, the patient was tachycardic, tachypneic, with evidence of poor perfusion concerning for septic shock vs hemorrhagic shock. He was given many blood products for severe coagulopathy and required multiple fluid boluses and vasopressors for decompensated shock. He was then admitted to the intensive care unit for further management. After receiving octreotide and vitamin K, he was able to be weaned off vasopressor support and discharged on fat-soluble vitamin supplementation.

Vitamin K deficiency can cause significant coagulopathy in patients with short gut syndrome. Understanding this physiologic consequence of short gut syndrome can help facilitate early identification and management of a potentially life-threatening complication to improve patient outcomes.