Cholestatic doses for fat soluble vitamins

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cholestasis AND fat-soluble vitamins

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cholestasis fat soluble vitamin supplementation doses pediatric guideline vitamin A D E K

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https://www.ncbi.nlm.nih.gov/books/NBK6420

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cholestasis children fat soluble vitamin doses 5000 10000 25 IU kg vitamin K 2.5 mg

Typical pediatric cholestasis supplementation doses for fat-soluble vitamins:

Vitamin	Usual oral dose
A	<10 kg: 5,000 IU/day; >10 kg: 10,000 IU/day
D3 (cholecalciferol)	2,000-5,000 IU/day
E	TPGS/tocophersolan 15-25 IU/kg/day
K1 (phytomenadione)	2.5-5 mg/day or 2.5-5 mg 2-7 times/week, individualized to INR/PT

For refractory deficiency or severe cholestasis, doses and route may need escalation. One pediatric guideline table uses: vitamin A IM 50,000 IU monthly; vitamin D as 25-OH-D 80-200 IU/kg/day or IM 30,000 IU every 1-3 months; vitamin E IM 10 mg/kg every 2-3 weeks; and vitamin K IM 5-10 mg every 2 weeks.

Use water-miscible formulations, particularly TPGS for vitamin E, where available. Monitor retinol, 25-OH vitamin D, alpha-tocopherol-to-total-lipid ratio, PT/INR or PIVKA-II, calcium/phosphate/ALP, and adjust doses. Avoid unmonitored vitamin A escalation because hepatotoxicity is possible. The GI textbook notes vitamin E 100 mg daily can be used in chronic cholestasis with low serum vitamin E in adults. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, p. 1181.

These are commonly quoted pediatric cholestasis doses, not routine RDA doses. A pediatric cholestasis dosing review and neonatal cholestasis guideline table support these ranges.

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