VII. EFFECTS OF DEFICIENCY 425 



ing in patients with obstructive jaundice when crude vitamin K concen- 

 trates were administered orally, along with bile. Bile alone was slowly effec- 

 tive, but the vitamin alone was without any effect. Thus it became established 

 that, like the other fat-soluble vitamins, vitamin K requires bile for its 

 transport through the intestinal wall. Desoxycholic acid, which unites with 

 vitamin K to form vitamin K-choleic acid,^^ is claimed to be the principal 

 component of bile for absorption of the vitamin.'*^ Butt and SnelH^ demon- 

 strated that human acholic stools are rich in vitamin K, so that for coagula- 

 tion all that seems to be lacking in obstructive jaundice is the bile. It is 

 therefore puzzling why bile alone, although free of vitamin K,^^ is not more 

 efficacious when one considers the small amount of vitamin K necessary to 

 correct the deficiency (1 mg. or less).^^ 



As might be expected, water-soluble analogs of vitamin K may be given 

 orally, without supplementary bile, to animals or man lacking intestinal 

 bile.*° However, the water-soluble preparations are usually given parenter- 

 ally because of the prompter action and insured dosage. ^^ 



(2) Intestinal Disease. Altered blood coagulation is at times found in a 

 variety of intestinal diseases and conditions: intestinal obstruction, gastro- 

 colic fistula, external enterostomy, chronic ulcerative colitis, regional ileitis, 

 intestinal polyposis,^^- ^^ and tuberculous enteritis. ^^ Apparently vitamin K 

 is mechanically prevented from being absorbed in these conditions. The 

 vitamin deficiency which occurs in sprue, both tropicaP^ and non-tropical,^^ 

 and in prolonged diarrhea (such as in pellagra) ^^ likewise represents an 

 inability to absorb the vitamin K which is abundantly present; this state 

 may be duplicated experimentally by a high concentration of mineral oil 

 in the diet.^^ Activated carbon, by firmly adsorbing vitamin K, also pre- 



« H. J. Almquist and A. A. Klose, /. Am. Chem. Soc. 61, 745 (1939). 



« E. T. Cohn and C. L. A. Schmidt, Proc. Soc. Exptl. Biol. Med. 41, 443 (1939). 



" H. R. Butt and A. M. Snell, Vitamin K. W. B. Saunders Company, Philadelphia, 



(1941). 

 « H. J. Almquist, Science [N. S.j 87, 538 (1938). 



49 E. Fernholz and S. Ansbacher, Science [N. S.] 90, 215 (1939). 



50 E. D. Warner and J. E. Flynn, Proc. Soc. Exptl. Biol. Med. 44, 607 (1940); H. P. 

 Smith and C. A. Owen, /. Biol. Chem. 134, 783 (1940). 



51 H. P. Smith, S. E. Ziffren, C. A. Owen, and G. R. Hoffman, J. Am. Med. Assoc. 

 113, 380 (1939); H. R. Butt, A. M. Snell, and A. E. Osterberg, Proc. Staff Meetings 

 Mmjo Clinic 14, 497 (1939). 



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

 Maijo Clinic 14, 407 (1939) ; T. T. Mackie, N. Y. State J. Med. 40, 1'art 2, 987 (1940). 



" E. Tanner and F. Suter, Schweiz. med. Wochschr. 74, 552 (1944). 



" R. S. Diaz y Rivera, Puerto Rico J. Public Health Trap. Med. 17, 124 (1941). 



55 E. D. Warner, T. D. Spies, and C. A. Owen, Southern Med. J. 34, 161 (1941). 



56 M. C. Elliott, B. Isaacs, and A. C. Ivy, Proc. Soc. Exptl. Biol. Med. 43, 240 (1940); 

 W. A. Barnes, ibid. 49, 15 (1942). 



