Table 1.
Common micronutrient deficiencies, their symptoms, and guidance for supplementation after biliopancreatic diversion
| Deficiency | Signs and symptoms [10, 22–24] | Supplementation in case of deficiencya [25] |
|---|---|---|
| Fat soluble vitaminsb | ||
| Vitamin A | Night blindness | No corneal changes: 10,000–25,000 IU per day orallyc; corneal changes: 50,000–100,000 IU administered intramuscularly (3 days) followed by 50,000 IU intramuscularly (two weeks). |
| Vitamin D | Osteoporosis, fractures | 3000–6000 IU per day orally |
| Vitamin E | Ataxia, loss of vibration or position sense, muscle weakness | Optimal therapeutic dose undefined |
| Vitamin K | Coagulation disorder (bleeding or bruising) | 1–2 mg per day orally in case of acute malabsorption or 1–2 mg per week intravenously in case of chronic malabsorption |
| Water soluble vitamins | ||
| Vitamin B1 (thiamine) | Gastro-enterologic: nausea, vomiting; Wet beriberi: cardiovascular symptoms; Dry beriberi: neurological symptoms (Wernicke-Korsakov syndrome) | Orally: 100 mg (2–3x per day); Intravenously: 200 mg (3x per day) or 500 mg (1-2x per day) until symptoms resolve and consider oral therapy afterwards (100 mg); Intramuscularly: 250 mg (1x per day during 3–5 days) or 100–250 mg (1x per month). |
| Vitamin B9 (folic acid) | Fatigue, anaemia, cognitive impairment, depression | 1000 μg per day orallyd |
| Vitamin B12 (cobalamin) | Neuropathy, muscle weakness, fatigue, anaemia, mood disorders | 1000 μg orally or intramuscularly |
| Trace metals | ||
| Iron | Fatigue, microcytic anaemia, hair loss, brittle nails, angular cheilosis | 150–200 mg of elemental iron orallye, in non-responders intravenous iron infusion should be considered |
| Zinc | Diarrhoea, anaemia, hair loss, glossitis, hypogeusia, delayed wound healing, skin lesions and mental abnormalities | Optimal therapeutic dose undefined |
| Copper | Painful neuropathy, anaemia, neutropenia, optic neuropathy, fatigue, iron deficiency | Mild to moderate deficiency: 3–8 mg per day orally; Severe: 2–4 mg per day intravenously |
a daily required dose in case of deficiency detected by biochemical monitoring; b titrate individually, higher doses of substitution may be required following malabsorptive procedures; c Caution to avoid toxicity, especially in patients with kidney disease who have reduced vitamin A clearance; d more than 1 mg not recommended because of the potential masking of vitamin B12 deficiency; e separate from calcium supplements and gastric acid-reducing medications, association of vitamin C enhances ferric iron absorption