2777 Nutritional Deficiencies in a Patient With Roux-en-Y Gastric Bypass Surgery

Abstract

INTRODUCTION: Bariatric surgery is one of the most commonly performed surgeries in the US. Several types exist including vertical sleeve gastrectomy (VSG), adjustable gastric banding (AGB), and Roux-en-Y gastric bypass (RYGB). VSG and RYGB work through caloric restriction and neurohormonal changes. While there are many benefits of bariatric surgeries, there are also many complications including malabsorption of nutrients. CASE DESCRIPTION/METHODS: A 41-year-old African-American female with prior RYGB in 2014 presented to the hospital with general malaise, crampy abdominal pain, back and joint pain, nausea, dyspnea, and intermittent headaches with photophobia and phonophobia for the past 1 month. Labs revealed moderate microcytic anemia with hemoglobin of 9. Reticulocytes were depressed at 13.8. Metabolic panel was within normal limits. Rheumatologic panel including ANA, C3/C4 was negative. On exam, pertinent findings included tachycardia and epigastric tenderness with deep palpation. She had multiple 1 cm hyperpigmented circular lesions on the forehead, upper back, and bilateral upper arms. This prompted testing for copper and zinc, which were decreased at 26 and 54, respectively. CT abdomen/pelvis with contrast showed a small pericardial effusion but was otherwise normal. MRI brain showed no changes to prior images. The patient was discharged on a multivitamin with zinc and copper to follow up with her PCP. DISCUSSION: Copper and zinc are essential nutrients for humans and act as cofactors for a variety of metalloenzymes that participate in critical body functions. Deficiency in these nutrients is rare in the US as it’s found in commonly consumed foods. Copper deficiency results in brittle hair, skin depigmentation, neurologic dysfunction, and osteoporosis. Zinc deficiency can result in pustular skin rash, impaired taste, and immune dysfunction 4Zinc and copper are usually not added to multivitamins and not routinely measured by physicians, however patients with modified GI physiology due to bariatric surgery can be at risk. RYGB reduces the stomach’s capacity and re-routes ingested food to bypass the duodenum, where copper and zinc are absorbed. Patients with a history of gastric bypass surgery and ill-defined symptoms should be tested for trace mineral deficiencies. Patients who recently underwent a gastric bypass, particularly a RYGB, should be placed on a multivitamin that includes zinc and copper.

Dermatological manifestations relating to nutritional deficiencies after bariatric surgery: case report and integrative literature review

“…77,87 As demonstrated in Table 1, among the 41 patients selected, 27 had systemic manifestations and these were potentially fatal or fatal in 11 patients. 37,41,43,[46][47]49,50,61,65,67 Although not the purpose of this review, it is also necessary to consider that there are cutaneous manifestations that occur after bariatric surgery, which are not due to nutritional deficiency. On the contrary, these are due to excessive replacement of micronutrients, a situation seen with relative frequency in patients in the late postoperative period of bariatric surgery.…”