Postoperative Management and Nutritional Deficiencies
A 52-year-old woman presents for her annual postoperative bariatric surgery appointment. She underwent Roux-en-Y gastric bypass (RYGB) 3 years ago. Since then, she has lost more than 100 lbs. and no longer requires antihypertensive medication. In reviewing her diet, she reports becoming a vegan over the past year and has continued to avoid sweets and carbonated beverages. Six months ago, she sustained a left wrist fracture after tripping on the sidewalk. She also reports generalized fatigue and tingling in her fingers and toes for the past 2 months. She admits to not taking her vitamins as recommended. On exam, she weighs 161 lbs. with a BMI of 26.8 kg/m2. She is afebrile with a blood pressure of 120/60 and heart rate of 95 beats/min. A beefy, red tongue and pale conjunctiva are notable. The rest of her exam including neurological assessment is otherwise normal. Labs reveal hemoglobin 10.8 g/dl [normal 11.2–14.7] and hematocrit 33.7% [normal 33.8–43.3] with an MCV of 105 fL [normal 79.4–94.7]. Serum folate is 10 ng/ml [normal ≥4.8] and vitamin B12 is 150 pg/ml [normal 299–1054]. Methylmalonic acid is elevated. 25-hydroxyvitamin D is 8 ng/ml [normal ≥20 ng/ml]. Basic metabolic panel is normal and other micronutrient labs are normal.
KeywordsBariatric surgery Roux-en-y gastric bypass Micronutrient deficiency Malabsorption Vitamin supplementation
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