Bariatric Beriberi (Not a new flavored juice for weight loss)

From Brucemhood.wordpress.com

Say that 3 times... bet you can if you try (Mr. Rogers flashback, anyone?).

                 Nicely done.

Beriberi, or classic Thiamin (B1) deficiency is not all that uncommon in Bariatric surgery circles.  And, that makes some sense, especially in post-Bypass patients, and yet we are finding it so as well for Sleeve Gastrectomy patients, as reported in the literature.  B1 acts in the body as a cofactor in several enzymes associated with CHO metabolsm and energy production.  It's effects are most noticeable in the cardiovascular and neurological organ systems.

Thiamin is preferentially absorbed in the duodenum, with decreasing absorption caudally along the small intestine in an intact GI tract.  Therefore, a Bypass certainly increases the risk of having an issue with Thiamin, as the procedure essentially re-routes nutrient exposure away from these areas of maximal absorption.

Literature reviews show that 'Bariatric Beriberi' is most common in the setting of protracted vomiting, typically within the first 2-3 mos after a Gastric Bypass.  It is purported to be brought on by rapid weight loss and dietary insufficiency, as well as lack of strict adherence to required vitamin regimens.

For post op vitamin regimens, as detailed earlier in this blog, we usually advise a MVI and B Complex, among others,  which along with a reasonably sound diet, should keep their Thiamin levels up to snuff, even with the varying degrees of malabsorption between the Bypass and the Sleeve patients.

And the risk of not being mindful of a patient with potential Thiamin deficiency and the need for IV fluid replacement?  They can exhibit signs and symptoms of Wernicke's Encephalopathy if given Dextrose in their IV fluid, with this coexistent micronutrient deficiency.  Manifestations of WE include ataxia, opthalmoplegia, nystagmus, and mental confusion.  In the worst case, it can be non-reversible, or even fatal.

We will always give a banana bag with MVI, 100 mg Thiamin, and even a Gram of Folate in our initial IV as to negate this risk when we admit a post op patient who fits this description.  As much as we educate our hospital staff, and the ER staff, we still cringe when we see an occasional patient with D5(name your flavor....) hanging as an initial IV in a sick patient that has been vomiting, and with poor PO intake.  For additional monitoring, we do include a B1 level on our post op labs that we check regularly in the post op setting.

You should see a copy of those labs we check as we CC you on the labs as much as possible.