Multivitamin Deficiency Research Articles

Hypocalcemic Tetany, Growth Failure, Primary Amenorrhea and Iron Deficiency in an Adolescent Girl

A 15-year-old pale and wasted prepubertal Yemeni girl presented with carpo-pedal spasms of the limbs and drowsiness after severe bilateral thigh pain and weakness for a few days. She denied any trauma or taking medications but complained of recurrent abdominal pains and distension with occasional diarrhea. Her height = 119 cm and weight = 19.5 kg, BMI = 13.7. Her quadriceps were contracted bilaterally and there was exquisite pain on palpation of both thighs. Deeptendon reflexes were brisk all over and Chvostek sign was positive. Abdomen appeared distended with no organomegaly. Tests showed hypocalcemia, hypophosphatemia, hypomagnesemia, high PTH and low vitamin D 25-hydroxy level, hypoalbuminemia, low B12 and low RBC folate, normal ESR with normal renal and hepatic functions. Tissue transglutaminase antibody was positive but stools negative for fat. Upper gut endoscopy revealed total villus atrophy. Bone age was nine years with osteomalacia. She was diagnosed with celiac disease plus multivitamin deficiency and was treated with vitamin D3 (600, 000 U)IM, calcium carbonate, B12 100 meg IM, multivitamins, and Fe-sulfate. She was put on a gluten-free diet with increased calcium intake. Two months later, her weight had increased by 5 kg, height by 4 cm and her appetite improved markedly with disappearance of all abdominal symptoms and cramps. Adolescents with delayed puberty and short stature must be screened for celiac disease.

After bariatric surgery, what vitamins should be measured and what supplements should be given?

Bariatric surgery is the most effective treatment for morbid obesity. Although calorie malabsorption does not occur in most bariatric procedures, micronutrient deficiencies are possible. Multivitamin supplementation is essential following bariatric surgery. The recommendation would be to screen for multivitamin deficiencies prior to surgery and to monitor vitamin levels postoperatively at regular intervals. In this paper, we review the data for screening and supplementation after bariatric procedures for different vitamins.

Laparoscopic Gastric Bypass Complicated by Portal Venous Thrombosis and Severe Neurological Complications

The laparoscopic Roux-en-Y gastric bypass (LRYGBP) is increasingly popular for the treatment of morbid obesity, although its postsurgical complications are often underestimated. We report the case of a 22-year-old morbidly obese woman who underwent a LRYGBP, which was rapidly complicated by portal venous thrombosis and severe neurological complications due to vitamin deficiencies. She presented rapid body weight loss with optic and peripheral neuropathy. Clinical chemistry results showed low transthyretin and micronutrient levels. Intravenous micronutrient infusion and cyclic nocturnal enteral tube feeding were needed to slowly improve gait and visual acuity. We then discuss (1) factors that could have contributed to the nutritional deficiencies and (2) the preventive management of these types of nutritional complications. Gastric bypass procedures can cause multivitamin deficiencies. In the case presented here, complications occurred very soon after surgery. The increasing incidence of obesity and bariatric surgery warrants better patient education concerning strict adherence to vitamin supplementation.

The Peroxide-Erythrocyte Hemolysis Test: Experiences in Patients with Cirrhosis, Jaundice, and Polyneuritis

Red blood cell sensitivity to hemolysis with hydrogen peroxide has been determined in 52 patients, 49 of whom had cirrhosis. No definite correlation was found with the severity of cirrhosis, the presence of jaundice, or the presence of “alcoholic hyalin” and necrosis of the liver. Only two patients had strongly positive tests (greater than 50 per cent hemolysis), and both had multivitamin deficiency with mild cirrhosis and severe polyneuropathy suggesting but not proving vitamin E deficiency in these two patients.