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Bariatric Surgery - Obesity Algorithm 2024

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24 Nutrient Considerations Micronutrient Deficiency Replacement After Bariatric Surgery: Vitamins Vitamin/ Mineral Assessment Replacement of Deficiency and Maintenance Vitamin B9 (Folate) Red blood cell (RBC) folate • If daily bariatric multivitamin has 800 mcg of folic acid, then replacement dose for deficiency is an additional 400 mcg/day supplement (total of 1200 ug/d of folic acid until RBC folate in normal range); maintenance dose is 800 mcg of folic acid, as often found in many bariatric multivitamins B12 (Cobalamin) Vitamin B12 • B12 def iciency: treat with 1000 mcg or 1 mg per day orally by disintegrated tablet, sublingually, liquid, or parenteral (IM or SQ) • B12 is also available by nasal spray, with dose as per manufacturer • Once B12 in normal range, maintenance dose 500 mcg or 1000 mcg orally, as often found in many bariatric multivitamins, or 1000 mcg/ month IM (cont'd)

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