Peripheral Neuropathy and Severe Malnutrition following Duodenal Switch

Abstract

Severe thiamine (vitamin B-1) deficiency is a medical emergency that has long been recognized as a potential complication of bariatric surgery. The incidence of this rare complication is largely unknown. We describe a super-obese male patient with extreme lower limb weakness 3 months following a duodenal switch operation, occurring in association with persisting vomiting. Excessive malabsorption led to severe malnutrition, with lower limb edemas and clinical evidence of ascites and pleural effusion. Blood tests revealed low levels of albumin, hemoglobin, potassium, vitamins A, B-1, and B-6, and elevated prothrombin time. The symptoms of neuropathy improved after extensive nutritional therapy. Weight eventually stabilized following elongation of the common channel. This case report demonstrates the importance of awareness of neurological complications following bariatric surgery. These complications require urgent and vigorous therapy when they occur.

Neuropathy in Parkinson’s Disease Patients with Intestinal Levodopa Infusion versus Oral Drugs

“…For example, intestinal accumulation of the viscous gel could hamper jejunal membrane functions which could promote previously described B vitamin and folate deficiencies and run counter to the increased demand of these nutrients in LD treatment. Worthwhile to note similar cases of neuropathy have been observed after surgical resection of the upper jejunum and bariatric operations [18]–[20]. Such a mechanism would also be in line with the correlation of the reported weight loss and neuropathic damage obtained in LCIG patients.…”

Subacute axonal neuropathy in Parkinson's disease with cobalamin and vitamin B6 deficiency under duodopa therapy

“…Duodopa is infused directly into the upper jejunum, which has an important role in the absorption of vitamin B6 and cobalamin. This was confirmed by reports of patients with bariatric surgery using a duodenal switch16 or gastrojejunal bypass1,5, 17 who showed vitamin B6 and cobalamin deficiency with GBS‐like polyneuropathies. However, not all patients under duodopa therapy develop neuropathy, and it is not known if a genetic susceptibility in PD patients might be a risk factor for the development of PN under high‐dose L‐dopa therapy.…”

Nutritional Deficiencies in Obesity and After Bariatric Surgery

“…[83] Risk factors include excessive post-operative vomiting leading to reduced intake and non-adherence to multi-vitamin supplementation. [84] Rapid identification and treatment with intravenous supplementation can rapidly improve visual loss and promote resolution of neurologic sequelae, while delay in repletion can cause permanent disability. [81]…”