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Bariatric Surgery - Obesity Algorithm 2024

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26 Nutrient Considerations Micronutrient Deficiency Replacement After Bariatric Surgery: Vitamins/Minerals Vitamin/ Mineral Assessment Replacement of Deficiency and Maintenance Vitamin K Prothrombin time • If vitamin K deficiency occurs due to acute gastrointestinal malabsorption, then vitamin K can be replaced 10 mg by slow IV • A typical oral replacement dose is 90–120 mcg/day vitamin K • Many bariatric multivitamins have 120–300 mcg vitamin K • Continued treatment depends on the persistent malabsorptive effects, most likely with biliopancreatic diversion/ duodenal switch, which may require 300 mcg/day vitamin K Calcium Calcium • Need to ensure adequate vitamin D • Calcium deficiency is often treated with calcium citrate 1200–1500 mg/d, or 1800–2400 mg/d after BPD/DS – preferably in divided doses to enhance absorption • Maintenance dose is generally similar to treatment doses • Calcium citrate may be better absorbed than calcium carbonate and is often preferred • Oral calcium bariatric supplements (tablets and chewable) often contain 250–500 mg of calcium; typical liquid preparations may contain 500, 600, 1200 mg per tablespoon • Calcium is best taken at least 1 hour apart from other supplements, especially iron (which competes for absorption) Copper Copper • For mild to moderate deficiency, 3–8 mg/d oral copper gluconate or sulfate • For severe deficiency, 2–4 mg/d IV copper for ~one week or until blood levels, signs, and symptoms resolve • Maintenance dose is 1–2 mg/d as often found in many bariatric multivitamins

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