The fat soluble vitamins are D, E, K and A. Shortages of these vitamins will occur in patients with short bowel syndrome who cannot absorb sufficient fat. Lack of vitamin D in the short term may result in tetany and in the long term will result in osteomalacia. Lack of vitamin E may result in increased oxidative damage. Lack of vitamin K will result in bleeding due to the inabilty of the liver to activate factors 2, 7, 9 and 10 (gamma carboxylation). Lack of vitamin A will result in night blindness, xero-stomia and xeropthalmos.
Vitamin B12 becomes deficient due to lack of ileal receptors for absorbion of the Vitamin B12 intrinisc factor complex . The liver will store sufficient vitamin B12 to last about two and a half years. The consequences of B12 deficiency are glossitis, lemon yellow jaundice, Hepatomegaly, neuropathy and macrocytic anaemia. The neuropathy usually commences with sensory loss of the glove and stocking type in the lower limbs, this is accompanied by loss of the tendon reflexes then loss of vibration sense and proprioception (posterior columns) and finally a spastic paraparesis when the lateral columns go.
Vitamin B12 is usually replaced by the administration of vitamin B12 injections. For a usual maintenance booster a shot once every three months is probably suficcient. However many people are recommended to receive an injection once a month.