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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
