Nutritional Deficiencies following Bariatric Surgery: What Have We Learned?

Bloomberg, Richard D; Fleishman, Amy; Nalle, Jennifer E; Herron, Daniel M.; Kini, Subhash

doi:10.1381/0960892053268264

Cited by 446 publications

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“…1 However, laboratory studies of iron deficiency usually show a microcytosis, whereas macrocytes predominated on our patient's peripheral smear, making iron deficiency an unlikely explanation for her anemia. Autoimmune hemolytic anemia is due to the development of IgG or IgM antibodies that react with protein antigens on the red blood cell surface.…”

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confidence: 57%

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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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confidence: 57%

“…Their deficiencies lead to megaloblastic anemia, which at this point is the most likely diagnosis for this patient. 1 The patient was admitted for blood transfusions and further work-up. A review of systems revealed that she had begun to become "clumsy" during the past 2 years.…”

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confidence: 99%

38-Year-Old Woman With Increasing Fatigue and Dyspnea

Khambatta

Nguyen

Wittich

2010

Mayo Clinic Proceedings

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“…Some authors suggested that neurological complications following bariatric surgery were due to disturbed protein and vitamin metabolism (10). Deficiencies of iron, zinc, cobalamine (B12), thiamine (B1) and fat-soluble vitamins such as A, D, E, K were determined (10).…”

Section: Discussionmentioning

confidence: 99%

Bariatrik Cerrahi Sonrası Gelişen Nütrisyonel Polinöropati: Alışılmış Bir Klinikle Ortaya Çıkan Nadir Bir Olgu

...

2012

Tftr

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Sum maryWith rising frequency of bariatric surgery, the common adverse effects of that procedure is more frequently encountered. Our patient unluckily developed pulmonary embolism after 3 months of bariatric surgery and that clinic picture was aggravated with proximal lower extremity weakness and numbness. Electromyography performed on admission revealed asymmetric polyradiculopathy with axonal degeneration, whereas somatosensory evoked potentials showed no tibial peripheric and cortical responses. Although we found no sign of malabsorption (except 25 OH vitamin D deficiency), the history of weight loss of 70 kg within 3 months after the surgery led us to the diagnosis of nutritional polyneuropathy. On the other hand, neuropathic pain in our patient responded well to pregabalin and, after strengthening of muscles via rehabilitation, the patient gained independent mobility again. Turk J Phys Med Re hab 2012;58:151-3. Key Words: Bariatric surgery, polyneuropathy,neuropathic pain Özet Bariatrik cerrahilerin daha sık uygulanması sonucunda bu prosedürün yan etkilerine daha çok rastlanılmaktadır. Hastamızda talihsiz bir şekilde bariatrik cerrahiden 3 ay sonra pulmoner emboli gelişmiş ve bu klinik tablo proksimal alt ektstremitede güçsüzlük ve hissizlik ile ağırlaşmıştır. Yapılan elektromyografik inceleme sonucunda aksonal dejenerasyonun hakim olduğu asimetrik polinöropati tanısı konmuş, duysal uyandırılmış potansiyallerde tibial periferik ve kortikal cevaplar alınamamıştır. İncelemeler sonucunda 25 OH Vitamin D eksikliği dışında bir vitamin ya da mineral eksikliği saptanmazken, hastanın operasyon sonrası 3 ay içerisinde 70 kg kaybetmesi bizi nütrisyonel polinöropati tanısına yönlendirmiştir. Diğer yandan hastamızın nöropatik karakterdeki ağrısı pregabaline iyi yanıt vermiş ve kas güçlendirme eğitimi sonrasında hastamız mobilitede bağımsızlığa kavuşmuştur.

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“…While research has shown successful treatment outcomes with intravenous iron replacement, clinical guidelines for post-RYGB administration of intravenous iron preparations vary considerably and access to intravenous iron replacement may be limited in the primary care setting because of: (a) delayed recognition of the severity of the deficiency; (b) a lack of consistent diagnostic criteria, indications, and optimal treatment goals; (c) provider concerns related to potential adverse effects of intravenous iron preparations; and (d) access to infusion centers for monitored treatments (Bailie, 2012;Bloomberg, Fleishman, Nalle, Herron, & Kini, 2005;DeFilipp et al, 2013;Malone, Alger-Mayer, Lindstrom, & Bailie, 2013;von Drygalski & Andris, 2009). …”

Section: Clinical Presentationmentioning

confidence: 99%

Malabsorption anemia and iron supplement induced constipation in post-Roux-en-Y gastric bypass (RYGB) patients

Sahebzamani

Berarducci

Murr

2013

Journal of the American Association of Nurse Practitioners

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Purpose Over 250,000 bariatric surgical procedures for the management of morbid obesity are performed in the United States annually. The Roux‐en‐Y gastric bypass (RYGB) is an effective bariatric procedure because of its efficacy in achieving significant weight loss, low complication rates, and outcomes in reducing cardiovascular and all cause mortality. Because food bypasses the portion of the small intestine whereby micronutrients are normally absorbed, micronutrient deficiencies following surgery may lead to iron deficiency anemia. Iron deficiency anemia is estimated to occur in 6%–50% of post‐RYGB patients. Consequently, the procedure requires lifelong behavioral change to ensure therapeutic iron supplementation. Data sources A nonsystematic literature search for clinical guidelines, review articles, and research was conducted. Conclusions Clinical recommendations include prophylactic iron supplementation with ferrous sulfate to prevent iron deficiency anemia. Ferrous sulfate is a well‐established cause of constipation possibly resulting in low patient tolerability and subsequent low adherence rates. Clinical implications Strategies for managing the side effects of iron supplementation including constipation may require a unique approach based on the anatomical and functional changes in the post‐RYGB patient and the requirement for lifelong iron supplementation.

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Nutritional Deficiencies following Bariatric Surgery: What Have We Learned?

Cited by 446 publications

References 35 publications

38-Year-Old Woman With Increasing Fatigue and Dyspnea

38-Year-Old Woman With Increasing Fatigue and Dyspnea

Bariatrik Cerrahi Sonrası Gelişen Nütrisyonel Polinöropati: Alışılmış Bir Klinikle Ortaya Çıkan Nadir Bir Olgu

Malabsorption anemia and iron supplement induced constipation in post-Roux-en-Y gastric bypass (RYGB) patients

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