News Release

Make sure you take your multivitamins after gastric bypass surgery for obesity

Peer-Reviewed Publication

The Lancet_DELETED

The case of a woman who developed a vitamin deficiency disease because she did not take her multivitamins after weight-loss surgery is studied in a Case Report in this week's edition of The Lancet, written by Dr Rachel Batterham and Dr Alberic Fiennes, Department of Medicine, University College London, UK, and colleagues.

The 27-year-old woman attended hospital with a 3-week history of dizziness, low-appetite, and vomiting, having had uncomplicated gastric bypass surgery two months earlier at University College Hospital, London, UK. Upon discharge after her weight-loss surgery, she was prescribed the standard treatments of multivitamins and lansoprazole — a drug which prevents the stomach producing acid.

Upon examination, she had rapid heartbeat and dehydration, and was provisionally diagnosed with gastric outflow obstruction; but an endoscopy (which involves a camera being passed into the stomach) revealed nothing of note. Since the surgery the woman had lost nearly 20kg, and blood tests gave results consistent with dehydration. She was given intravenous fluids, including glucose, and also drank high-sugar energy drinks. The next day, she felt light headed and collapsed in the shower, and had extremely low blood pressure. Further tests revealed abnormal eye movements, hyper-reflexia in her arms, weakness of the thighs, and reduced touch sensation — all of which led to the diagnosis of thiamine (vitamin B1) deficiency. Intravenous administration of thiamine began, and the patient made a full recovery. She admitted that she had not been taking her multivitamins.

Following gastric bypass surgery, vitamin supplements are necessary to make up the shortage of vitamins entering the body through food intake. Total body thiamine stores last 18-60 days, and deficiency can cause wet beriberi (cardiovascular problems), dry beriberi (nervous system problems) or Wernicke's encephalopathy (an acute neurological disorder characterised by eye movement problems). The woman in the Case Report had symptoms of all these three conditions. In high-income countries, thiamine deficiency is most commonly associated with chronic alcoholism, but also occurs in people with habitually restricted diets, gastrointestinal disorders, cancer, AIDS, severe infection, and kidney disease. But it can also occur after surgery for obesity. The authors conclude: "Wernicke's encephalopathy most commonly occurs 4-12 weeks after such surgery, mainly in people who have lost more than 7kg per month. Glucose administration can cause thiamine deficiency to manifest acutely, perhaps by using up remaining thiamine stores. If thiamine deficiency is suspected, thiamine should be administered before a patient is given glucose."

They add*: "Obesity surgery is becoming increasingly common as it is the only effective treatment for morbid obesity and reduces mortality and obesity associated diseases. Our case highlights the importance of vitamin supplementation and monitoring of thiamine levels in this patient group. In view of the non-specific nature of the initial beriberi presentation, a low-threshold should be adopted for intravenous thiamine administration, especially prior to high-glucose loads, in patients post-obesity surgery. This could indeed be lifesaving."

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Dr Alberic Fiennes, Obesity Surgeon, Department of Medicine, University College London, UK T) +44 (0) 7736 743134 E) alberic@agtwf.co.uk

*Notes to editors: quote direct from authors and not found in Case Report

Full Case Report: http://press.thelancet.com/beriberi.pdf


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