Vitamins And Minerals Flashcards
What are the Vitamin/Mineral Deficiencies that are common in BPD/Duodenal Switch (DS)?
- Protein
- Fat-Soluble Vitamins (A,D,E,K)
- Other micronutrient deficiencies
- Altered Calcium metabolism
- B1 (Thiamin) deficiency is common among all bariatric patients with frequent vomiting
What are the Vitamin/Mineral Deficiencies common in RNY Gastric Bypass Surgery patients?
- Iron
- Vitamin B12
- Vitamin D
- Changes in Calcium Metabolism
- B1 (Thiamin) - common among all bariatric patients with frequent vomiting.
What are the Vitamin/Mineral deficiencies common in Adjustable Gastric Banding (AGB) patients?
- Folate deficiency
- Telopeptide marker changes
- B1 (Thiamine) deficiency is common among all bariatric patients with frequent vomiting.
What is Thiamin?
- Water-soluble vitamin absorbed in the proximal jejunum by the active transport system.
What happens if there is not regular and sufficient intake of Thiamin?
- The tissues become rapidly depleted, because the total amount of thiamin that can be stored in the adult body is 30 mgs.
- The half life is 9-18 days.
What are the common causes of Thiamin deficiency?
- Persistent vomiting
- Low Thiamin diet
(Can result in severe depletion within only a short period of time, along with symptoms of BeriBeri.)
What are the symptoms of BeriBeri?
Symptoms of dry beriberi include: Difficulty walking. Loss of feeling (sensation) in hands and feet. Loss of muscle function or paralysis of the lower legs. Mental confusion/speech difficulties. Pain. Strange eye movements (nystagmus) Tingling. Vomiting. -Irreversible neuromuscular disorders -Permanent defects in learning and short-term memory -Coma -Death
How does Bariatric Surgery increase the risk of BeriBeri?
- It worsens pre-existing B1 (Thiamin) deficiencies.
- Causes low nutrient intake, including B1 (Thiamin)
- Malabsorption
- Episodes of nausea and vomiting
How do Chronic or Acute B1 (Thiamin) deficiencies often present?
- Peripheral Neuropathy
- Wernicke’s encephalopathy
- Psychoses
- —-Wernicke-Korsakoff syndrome, which combines Wernicke encephalopathy (see Wernicke’s Encephalopathy) and Korsakoff psychosis (see Korsakoff’s Psychosis), occurs in some alcoholics who do not consume foods fortified with thiamin. Wernicke encephalopathy consists of psychomotor slowing or apathy, nystagmus, ataxia, ophthalmoplegia, impaired consciousness, and, if untreated, coma and death. It probably results from severe acute deficiency superimposed on chronic deficiency. Korsakoff psychosis consists of mental confusion, dysphonia, and confabulation with impaired memory of recent events. It probably results from chronic deficiency and may develop after repeated episodes of Wernicke encephalopathy.
What is the suggested B1(Thiamine) Supplementation?
- MVI/minerals - at least 100% DV for B1 (Thiamin)
What may need to be done in regards to B1(Thiamine) supplementation, in patients having episodes of nausea and vomiting or anorexia?
- They may require sublingual, IM or IV B1 (Thiamin) to avoid depletion of B1 (Thiamin) stores and increased risk for BeriBeri.
What caution needs to be taken when infusing bariatric surgery patients with dextrose?
-The IV must contain B1 (Thiamin) to decrease the risk for depletion.
Vitamin Supplementation for VSG
B12 - Decreased amount of intrinsic factor since the greater curve of the stomach is resected.
Multivit with FE
Calcium
Vitamin D - if preoperative levels were low
How can bariatric patients with Thiamin (B1) deficiency be treated?
Thiamin (B1), together with-
- Other B-Complex vitamins
- Magnesium
for maximal thiamin absorption and appropriate neurological function
How can early symptoms of neuropathy often be resolved?
Thiamin (B1) 20-30mg/day until symptoms disappear
How can more advanced signs of neuropathy or protracted vomiting be treated?
Thiamin (B12) 50-100mg/d IM or IV
What is the Thiamin (B1) treatment for patients with Wernicke-Korsakoff?
Thiamin (B1) 100mg IV for several days, followed by IM or high oral doses, until symptoms are resolved or greatly improved. (May take months to years.)
Some patients have to take Thiamin (B1) for life to prevent the recurrence of neuropathy.
Which procedure causes incomplete digestion and release of B12 from protein foods?
RNY gastric bypass
Why is there incomplete digestion and release of B12 from protein foods with RNY GB?
Significant decrease in HCL (Hydrochloric Acid)
Pepsinogen cannot be converted into pepsin
So the body can’t release B12 from the protein
Why is reduction in HCL with resulting B12 deficiency, not common in Adjustable Gastric Band patients?
Because they have complete use of the stomach - no anatomical changes have been made.
Why is there not a reduction in HCL and subsequent B12 deficiency prevalent in BPD/DS patients?
Not as great a restriction in stomach capacity and HCL producing parietal cells as RNY GB patients.
What are the causes of B-12 Deficiency?
- Inability to release protein-bound vitamin B12 from food
- Malabsorption due to inadequate Intrinsic factor (eg. Pernicious anemia)
- Gastrectomy and Gastric bypass
- Resection or disease of the terminal ileium
- Long term vegan diet
- Medications - eg. neomycin, metformin, colchicines, PPI’s
Recommended G12 Screening and Supplementation
- Deficiency = <200 pg/ml
- Approximately 50% of patients with obvious s/s of deficiency have normal B12 levels
- MMA more accurate screening for B12
- Deficiency usually resolves after several weeks of treatment with 700-2000 mcg/week
What is the recommended B12 Supplementation?
- 350-600 mcgs oral crystalline B12 (prevented deficiency in 95% of patients)
- Oral dose of 500 mcg is sufficient to overcome an existing deficiency.
- ~1% of supplemental B12 is absorbed passively by diffusion if there is an increased dosage.
