Need for parenteral iron therapy after bariatric surgery

Varma, Seema; Baz, Walid; Badine, Edgard; Nakhl, Fadi; McMullen, Heather; Nicastro, Jeffrey; Forte, Frank; Terjanian, Terenig; Dai, Qun

doi:10.1016/j.soard.2008.04.015

Cited by 48 publications

(37 citation statements)

References 16 publications

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“…Notably, she had been receiving oral iron replacement therapy as an outpatient for several months. She had also been receiving B 12 supplements intramuscularly once weekly since her neurologic symptoms began, but her symptoms had continued to progress. Her serum iron, transferrin, ferritin, B 12 , and folate levels were all normal.…”

Section: Which Onementioning

confidence: 99%

“…B 12 . Consensus has not been reached on the dose and route of administration, but an oral dose of 500 µg/d or a monthly injection of 1000 µg of vitamin B 12 is generally considered adequate to maintain serum levels on a long-term basis.…”

Section: Which One Of the Following Nutritionalmentioning

confidence: 99%

“…Parenteral iron may need to be administered to replenish or maintain iron stores. 12 Thiamine deficiency leading to Wernicke encephalopathy (ophthalmoplegia, ataxia, and encephalopathy) may occur if patients develop persistent vomiting after surgery. Patients who do not experience excessive vomiting usually need only thiamine in their multivitamin supplement.…”

Section: Which One Of the Following Nutritionalmentioning

confidence: 99%

“…3 Our patient had a normal platelet count and renal function, with none of the described risk factors, making the diagnosis of hemolytic uremic syndrome unlikely. Vitamin B 12 and folate deficiencies often coexist, and it is difficult to distinguish between them on a clinical basis. Their deficiencies lead to megaloblastic anemia, which at this point is the most likely diagnosis for this patient.…”

mentioning

confidence: 99%

“…Heel to shin motion was difficult to accomplish. 12 deficiency presents neurologically as subacute combined degeneration of the dorsal and lateral spinal columns due to a defect in myelin formation. The neuropathy is symmetrical and usually affects the legs more than the arms.…”

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38-Year-Old Woman With Increasing Fatigue and Dyspnea

Khambatta

Nguyen

Wittich

2010

Mayo Clinic Proceedings

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A 38-year-old woman presented to the emergency department because of increasing fatigue and shortness of breath, worsening during the past 2 months. At the time of presentation, even minimal exertion caused her to become short of breath. She denied chest pain, cough, expectoration, orthopnea, paroxysmal nocturnal dyspnea, recent fevers, or chills. Her medical history was remarkable for a Roux-en-Y gastric bypass procedure 16 years earlier for morbid obesity. Her weight before surgery was approximately 100 kg (220 pounds), but she had lost considerable weight after surgery, with her recent weight being stable at around 57 kg (125 pounds). She had a history of frequent upper respiratory tract infections, urinary tract infections, and yeast infections since her obesity surgery.Physical examination revealed a pale woman who appeared malnourished and in mild distress. She was afebrile. The patient's vital signs were as follows: pulse rate, 110 beats/min; respiration rate, 16 breaths/min; and blood pressure, 110/70 mm Hg. Her pulse oximetry revealed normal oxygen saturation while breathing room air. A grade 2/6 systolic ejection murmur was heard over the left sternal border. Her chest was clear to auscultation bilaterally. Examination or her ear, nose, and throat was remarkable for cheilitis and glossitis.A complete blood cell count yielded the following results (reference ranges shown parenthetically): hemoglobin, 6.1 g/dL (12.0-15.5 g/dL); hematocrit, 18.1% (34.9%-44.5%); mean corpuscular volume, 104 fL (81.6-98.3 fL); white blood cell count, 1.1 × 10 9 /L (3.5-10.5 × 10 9 /L); and platelet count, 254 × 10 9 /L (150-450 × 10 9 /L). She had a blood urea nitrogen level of 17 mg/dL (6-21 mg/dL), a creatinine level of 0.7 mg/dL (0.6-0.9 mg/dL), and a reticulocyte count of 2.11% (0.60%-1.83%). A differential white blood cell count revealed 66% lymphocytes (16%-52%), 19% monocytes (1%-11%), and 11% neutrophils (42%-75%). A peripheral smear revealed mostly macrocytes, few hypochromic microcytes, and dacrocytes, with no schistocytes or spherocytes.

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Section: Which Onementioning

confidence: 99%

Section: Which One Of the Following Nutritionalmentioning

confidence: 99%

Section: Which One Of the Following Nutritionalmentioning

confidence: 99%

mentioning

confidence: 99%

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38-Year-Old Woman With Increasing Fatigue and Dyspnea

Khambatta

Nguyen

Wittich

2010

Mayo Clinic Proceedings

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Proceedings of the 2017 ASPEN Research Workshop—Gastric Bypass: Role of the Gut

Jain

Roux

Puri

et al. 2018

J Parenter Enteral Nutr

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The goal of the National Institutes of Health-funded American Society for Parenteral and Enteral Nutrition 2017 research workshop (RW) "Gastric Bypass: Role of the Gut" was to focus on the exciting research evaluating gut-derived signals in modulating outcomes after bariatric surgery. Although gastric bypass surgery has undoubted positive effects, the mechanistic basis of improved outcomes cannot be solely explained by caloric restriction. Emerging data suggest that bile acid metabolic pathways, luminal contents, energy balance, gut mucosal integrity, as well as the gut microbiota are significantly modulated after bariatric surgery and may be responsible for the variable outcomes, each of which was rigorously evaluated. The RW served as a timely and novel academic meeting that brought together clinicians and researchers across the scientific spectrum, fostering a unique venue for interdisciplinary collaboration among investigators. It promoted engaging discussion and evolution of new research hypotheses and ideas, driving the development of novel ameliorative, therapeutic, and nonsurgical interventions targeting obesity and its comorbidities. Importantly, a critical evaluation of the current knowledge regarding gut-modulated signaling after bariatric surgery, potential pitfalls, and lacunae were thoroughly addressed.

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Adherence to vitamin supplementation following adolescent bariatric surgery

Modi

Zeller

Xanthakos

et al. 2013

Obesity

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Adolescents with extreme obesity, who have undergone bariatric surgery, must adhere to many lifestyle and nutritional recommendations, including multivitamin therapy. Little is know about multivitamin adherence following adolescent bariatric surgery. The present study aims to document self-reported and electronically-monitored adherence to multivitamins, determine convergence between self-report and electronic monitoring adherence for multivitamins, and identify barriers to multivitamin adherence for adolescents who have undergone bariatric surgery. The study used a prospective, longitudinal observational design to assess subjective (self-reported) and objective (electronic monitors) multivitamin adherence in a cohort of 41 adolescents (Mean age = 17.1±1.5; range=13–19) who have undergone bariatric surgery at Cincinnati Children's Hospital Medical Center. Mean adherence as derived from electronic monitoring for the entire 6-month study period was 29.8% ± 23.9. Self-reported adherence was significantly higher than electronically monitored adherence across both the 1 and 6-month assessment points (z = 4.5, p< 0.000 and z = 4.0, p< 0.0001, respectively). Forgetting and difficulty swallowing multivitamins were the two primary barriers identified. While there are no established data regarding best practice for multivitamins following bariatric surgery, high rates of non-adherence to multivitamin therapy were observed in adolescents who had undergone bariatric surgery with forgetting and difficulty swallowing pills as reported barriers to adherence. These high rates of non-adherence to multivitamin therapy should be considered when devising treatment and family education pathways for adolescents considering weight loss surgery.

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Need for parenteral iron therapy after bariatric surgery

Cited by 48 publications

References 16 publications

38-Year-Old Woman With Increasing Fatigue and Dyspnea

38-Year-Old Woman With Increasing Fatigue and Dyspnea

Proceedings of the 2017 ASPEN Research Workshop—Gastric Bypass: Role of the Gut

Adherence to vitamin supplementation following adolescent bariatric surgery

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