VITAMIN' K HYPERVITAMIN'OSIS 775 



Another condition in which inadofiuate absorption of vitamin K is 

 found, resultino- in \'itannn K-deficiency, occurs in intestinal disease. 

 Thus, in a nTunl)er of pa1hoIof);ic coiKhtions sucli as intestinal obstruction, 

 gastrocolic fistula, external enteiostoniy, chronic ulcerative colitis, re- 

 gional ileitis, intestinal polyposis, -'''"'-'•* and tuberculous enteritis,-'* 

 the absorption of vitamin K is mechanically prevented. In other diseases, 

 such as tropical'-"' and non-tropical'-'- sprue and in the prolonged diarrhea 

 which sometimes occurs in pellagra,-'^ a similar condition occurs. 



AVhen the intestinal hnuph is diverted, there is a marked decrease in 

 clotting time in the blood of the rat.-'^ This condition can be corrected 

 by the administration of ^itamin K parenterally. Since the lymphatics 

 are the normal pathway of absorption of vitamin K, the withdrawal of 

 the intestinal or thoracic h^mph would be expected to prevent the transfer 

 of the vitamin from the intestinal wall to the liver and to other tissues. 



d. The Importance of the Liver in Vitamin K Utilization. After hepatec- 

 tomj', the clotting time of blood is prolonged.'-'^'--" It has also been known 

 for many years that a tendency to hemorrhage exists when there is severe 

 liver damage.--''^^- The reason for these findings was not understood 

 until a number of investigators^*'^^"^^'"--^ demonstrated that a lack of pro- 

 thrombin in the blood Avas a prominent condition associated with hepatic 

 disease, with occlusion of the liA'cr,--"* or following hepatectomy (evis- 

 ceration). --^•--'' Although vitamin K stimulates prothrombin synthesis 

 in normal livers, it is frequently unable to effect a similar formation of 



2'2 H. R. Butt and A. M. Snell, Vitamin K, Saunders, Philadelphia, 1941, pp. 96 

 ff. 



213 R. L. Clark, Jr., C. F. Dixon, H. R. Butt, and A. M. Snell, Proc. Staff Meetings 

 Mayo Clinic, 14, 407-416 (1939). 



2'^ T. T. Mackie, New York State J. Med., 40, 987-995 (1940). 



218 E. Tanner and F. Suter, Schweiz. med. Wochschr., 74, 552-554 (1944). 



216 R. S. Diaz y Rivera, Puerto Rico J. Public Health Trop. Med., 17, 124-128 (1941 ). 



2" E. D. Warner, T. D. Spies, and C. A. Owen, Southern Med. J., 34, 161-163 (1941). 



21* C. A. Owen, Jr., Studies on the Conversion of Prothrombin to Thrombin; Effect of 

 Conversion Variations on Prothrombin Tests. Thesis, Graduate School, Univ. Minnesota, 

 1950; cited bv W. H. Sebrell, Jr., and R. S. Harris, The Vitamins, Vol. II, Acad. Press, 

 NewYork, 1954, p. 426. 



219 M. Doyon and N. Kareff, Compt. rend. soc. biol, 56, 612-613 (1904). 



220 P. Nolf, Arch, intern, physiol., 3, 1-43 (1905-1906). 



221 M. Doyon, Compt. rend. soc. biol, 57, 30-31 (1905). 



222 M. Doyon, A. Morel, and N. Kareff, Compt. rend. soc. biol., 57, 493-494 (1905). 



223 H. P. Smith, E. D. Warner, and K. M. Brinkhous, /. Exptl. Med., 66, 801-81 1 

 (1937). 



22^ B. Uvnas, Acta Physiol. Scand., 3, 97-110 (1941). 



225 D. J. Ingle, Exptl. Med. & Surg., 7, 34-36 (1949). 



226 D. J. Ingle, J. E. Nezamis, and M. C. Prestrud, A7n. J. Physiol, 161, 199-201 

 (1950). 



