• Patients and families

• Health professionals

• Contacts

• Links

Information for health care professionals

• Home
• Newborn screening
• Diagnosis
• Airway cultures
• Staph aureus MSSA
• MRSA
• Pseudomonas
• Cepacia
• NTM
• Infection control
• Oral antibiotics
• Intravenous antibiotics
• Hearing loss
• Inhaled antibiotics
• DNase and HS
• Pancreatic enzymes
• Vitamin supplements
• Low vitamin D
• Salt supplements
• ABPA
• Bone disease
• CFRD
• DIOS
• Haemoptysis
• Liver disease
• Meconium ileus
• Transition

Vitamin supplements

Children with CF may become deficient of fat soluble vitamins (A, D, E and K) due to fat malabsorption. Fat soluble vitamin supplements should be taken with pancreatic enzyme supplements to maximise absorption. Vitamin levels (A, D and E) are measured once a year at annual review. If levels are low, the dose of vitamins is increased.

Vitamin A supplementation

1 microgram of vitamin A is equivalent to 3.3IU

Vitamin D supplementation

Note that 1 microgram of vitamin D is equivalent to 40IU

Vitamin E supplementation

Vitamin K supplementation

Vitamin K should be offered to all children aged 6 years (including pancreatic sufficient) and is mandatory for those with liver disease (with or without clotting abnormalities). The CF Trust nutrition guidelines suggest Vitamin K1 (phytomenadione) is used; unfortunately this is only available as a hospital special and cannot be sourced by community pharmacies. As a stand alone vitamin, Menadiol, a man-made water soluble version of vitamin K, can be used. The tablet can be swallowed or crushed and dissolved. The dose for 6 years and above is 10 mg once per day. Families that would like to use vitamin K supplements from 2 years of age can do so - the menadiol tablets can be broken, then crushed and dissolved - the dose for 2-6 year old is 5mg once per day.
Patients who take Aquadek are supplemented with vitamin K in the form of phytonadione but only at a low dose, and also need to take menadiol. (dose of vitamin K in Aquadek = 0.4mg/ml of liquid, 0.7mg per softgel, 0.35mg per chewable tablet). Paravit-CF dosing provides sufficient vitamin K.

Suitable vitamin preparations

For vitamin A and D

Our normal recommendation is to use Paravit-CF for all age groups (0.1mL for 0-1yr, 0.25ml or 1 capsule for 1-8yrs, 0.5ml or 2 capsules for over 8yrs).

The alternatives include 0.6ml Dalavit per day for children under 12 months and 1.2ml Dalavit for older children. Children who are able to swallow capsules may prefer A & D capsules (2-5 per day). If available, Aquadek liquid, chewable tablets or gelcaps are a good alternative. Aquadek softgel and chewable tablets have almost twice as much vitamin A for the same amount of vitamin D. For this reason some units recommend only using the liquid Aquadek preparation in children under 8 years of age.

For vitamin E

Vitamin E is also known as alpha tocopheryl. Note that 1mg of vitamin E is equivalent to 1-1.5IU depending on the exact preparation.

Vita E capsules come as 75IU, 200IU and 400IU, but only the 200IU is prescribable. One 200IU capsule per day is suitable for most children over 5 (under 5 they are unlikely to be able to swallow the capsule, which is a bit smaller than a creon capsule). Seperate vitamin E preparations are not needed in children taking Paravit, Aquadek or DEKAs.