|
Article Start
A woman developed disease because, after her weight-loss surgery, she
did not take her multivitamin, as reported in a Case Report released on
October 10, 2008 in The Lancet.
The obesity epidemic is well documented around the world, and has
affected developed countries in great magnitude. One treatment for
obesity is gastric bypass surgery, which actually limits the size of
the stomach cavity to help curb the patient's appetite.
The woman, 27 years old, was admitted the hospital after three weeks of
reported dizziness, loss of appetite, and vomiting. She had undergone
gastric bypass surgery, without complications, at University College
Hospital, London, UK.She was prescribed a standard treatment of
multivitamins and lansoprazole, which prevents stomach acid production,
upon discharge from the hospital.
When she was examined, she had lost almost 20 kilograms (44 pounds) and
presented with a rapid heartbeat and dehydration. This led to an
initial diagnosis of gastric outflow obstruction, but this diagnosis
could not be confirmed by endoscopic examination. Blood tests were
consistent with dehydration, so she was ultimately administered
intravenous fluids with glucose and drank high-sugar energy drinks.
The following day, she collapsed in the shower due to light-headedness,
and had an extremely low blood pressure. She was later observed to show
abnormal eye movement, hyper-reflexia in her arms, weakness in thighs,
and reduced touch sensation. This led to the ultimate
diagnosis: thiamine (vitamin B1) deficiency. After administration of
intravenous thiamine, the patient recovered. By her admission, she had
not been taking her multivitamins.
This highlights an important health care guideline that must be
carefully observed after gastric bypass surgery. Thymine storage in the
body can last only 18 to 60 days, and deficiency causes the disorder
known as Beriberi or Wernicke's encephalopathy, both of which were
shown by the woman described in the report.
Although in high-income countries, thiamine deficiency is usually
associated with chronic alcoholism, it can affect patients with
habitually restricted diets, disorders of the gastrointestinal system,
cancer, AIDS, serious infection, and kidney disorders. It is also a
potential result of obesity surgery.
In conclusion, the authors caution patients and doctors to be aware of
thiamine deficiency. %26#8220;Wernicke%26#8217;s encephalopathy
most commonly occurs 4%26#8211;12 weeks after such surgery, mainly in
people who have lost more than 7 kg 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,%26#8221; they write.
The authors finally note the importance of this information as gastric
bypass surgery becomes more common.: "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.%26#8221;
Can glucose make you faint?
Suehana Rahman, Antonia I Scobie, Mohamed Elkalaawy, Louise E Bidlake,
Alberic G Fiennes, Rachel L Batterham
Lancet 2008; 372: 1358
Click Here For Journal
Written by Anna Sophia McKenney
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Article End
|
