Complications from micronutrient deficiency following bariatric surgery

Abstract

We report a case of clinically significant micronutrient deficiencies following biliary pancreatic diversion (BPD) surgery. Our patient was admitted to hospital six years after BPD surgery following a low impact humeral fracture complicated by postoperative wound infection. On presentation she complained of a widespread rash and loss of night vision. Laboratory testing confirmed hypoalbuminaemia, deficiencies of vitamins A, E and D and of the trace elements copper, zinc and selenium. Bone densitometry confirmed osteoporosis. The skin rash was thought to be due to zinc deficiency and improved with conservative measures and trace element replacement. Her night blindness resolved 48 hours after receiving high dose parenteral vitamin A. Six months later she was readmitted to our intensive care unit with wound dehiscence at her fracture site and clinical features of sepsis and encephalopathy. This case highlights the importance of devising treatment and follow-up guidance prior to surgery and multidisciplinary team involvement including the patient so that long-term metabolic complications are avoided.

Parenteral trace element provision: recent clinical research and practical conclusions

“…In a recent case study, trace element deprivation including copper was reported following bariatric surgery. 53 …”

Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: Case report

“…Of special importance is the occurrence of hypocupremia. Reports of this phenomenon are becoming more common with increasing rates of obesity and consequently gastric bypass surgeries with resultant postoperative malnutrition states [15], [16], [17]. The greatly diminished copper absorption capacity (probably duodenum and proximal jejunum) [18] and inadequate supplementation of copper can be related to this problem.…”

Zinc

“…Patients who have had biliopancreatic diversion surgery are at greatest risk, with up to 92% reported to be deficient 1 year postoperatively 33 . This was illustrated by a recent case report in which a patient having biliopancreatic diversion surgery presented postoperatively with a wound infection and rash caused by severe Zn deficiency 34 . To prevent deficiency arising postoperatively, it is advisable to test Zn status preoperatively and to correct it, if necessary 35 .…”