Wednesday, March 10, 2010

Preventing Peripheral Neuropathy in Gastric Bypass Patients

This article comes from my medical school (UAMS).  The full reference is given below.  This topic is important to me because it relates to nutritional status of these patients who may present to my office for excess skin excision procedures, etc.

You may wish to read my related post from September 2008: Nutritional Deficiency of Post-Bariatric Surgery Body Contouring Patients: What Every Plastic Surgeon Should Know -- An Article Review

 

Here is part of the opinion statement from Dr. Rudnicki  published online:

Given the ever-increasing problem of obesity, it is not surprising that the number of patients who undergo bariatric surgery continues to rise. ………….

Ideally, one would like to prevent these neuropathies, but there is no consensus of opinion as to what vitamins and micronutrients need to be taken following bariatric surgery. In addition, many patients who take supplements early on fail to maintain the regimen even though some of the neuropathies can occur fairly late. Supplements frequently recommended include a multivitamin, iron, vitamin D, folic acid, calcium citrate, and vitamin B12. Although thiamine is typically included in a multivitamin, the amount is fairly small, so I recommend adding 100 mg daily for at least the first year. Some have suggested zinc supplementation, but this is potentially problematic because exogenous zinc may interfere with copper absorption. Obtaining blood work every 6 months after surgery will help to identify and treat nutritional deficiencies early.

For those patients who have had a bariatric procedure and then develop a neuropathy, evaluating levels of thiamine, copper, vitamin B12, methylmalonic acid, and homocystine is indicated. In addition, since one deficiency is frequently associated with others, obtaining levels of vitamin A, C, D, K, and E, as well as iron, zinc, selenium, and magnesium is worthwhile. Checking total protein, albumin, and cholesterol also gives a sense of general nutritional status. Occasionally, no clear-cut deficiency of a vitamin, mineral, or trace element can be identified in patients with various peripheral nervous system manifestations. Nevertheless, these patients may have at least some recovery with improving nutritional intake and vitamin supplementation, suggesting that we still do not fully understand how nutritional status affects the peripheral nervous system.

 

 

 

REFERENCE

Prevention and Treatment of Peripheral Neuropathy after Bariatric Surgery; Current Treatment Options in Neurology Vol 12, No 1, January 2010; Stacy A. Rudnicki, MD

DOI 10.1007/s11940-009-0052-2

1 comment:

StorytellERdoc said...

Interesting post, and a problem I wasn't fully aware of. More lit search now. We have a large bariatric population that visit us in our ER,and some are quite successfully handling their situation while others struggle a lot. With the risk of neuropathies added, I would hope a patient takes their time, does their research, and makes an informed decision that is right for them. Nice post, Ramona!