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首页> 外文期刊>Journal of the Endocrine Society. >MON-595 Severe Copper Deficiency Post-Bariatric Surgery with Serious Preventable Complications
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MON-595 Severe Copper Deficiency Post-Bariatric Surgery with Serious Preventable Complications

机译：Mon-595严重的铜缺乏症后肥胖症手术可预防并发症严重

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Copper is an essential cofactor in many enzymatic reactions vital to the normal function of the hematologic, vascular, skeletal, antioxidant, and neurologic systems. Parenteral nutrition and chronic tube feeding are used in various mal-absorptive syndromes, including following gastrectomy and gastric bypass surgery. Features of copper deficiency include hematologic abnormalities (anemia, neutropenia, and leukopenia) and myeloneuropathy; the latter is a rarer and often unrecognized complication of copper deficiency. We describe a 36 ‐year‐old Emirati woman who was referred to endocrinology service because of generalized body weakness and fatigue post bariatric surgery. The patient initially noted a lower extremity swelling in feet bilaterally that worsened in severity over time and progressed up to knees. Over a 3 month period, her ability to ambulate gradually deteriorated. She also noticed maculopapular skin rash over both shins. Patient had Sleeve Gastrectomy in 2011. Followed by conversion of sleeve to RYGB surgery in 2018 due weight loss failure. Patient is known to have well controlled hypothyroidism on thyroxine. She was prescribed vitamin D, neurobion, iron and multivitamins tablets post surgery but never been compliant. The patient was admitted with severe malnutrition due to poor oral intake over the last 5 months prior to admission. Her total weight loss was 34.5 kg (32% weight change, BMI 28 .52kg/m2) in less than 9 months post surgery. Initial labs revealed severe hypoalbuminemia, normochromic anemia and neutropenia. Iron, folate, thiamine, and vitamin B12 levels were normal. Vitamin B6 level was normal at 11 mcg/L (normal = 5-50 mcg/L). The serum copper level was low at 310 μg/l (normal = 794-2023μg/l). Zinc level was low at 447 μg/l (normal = 551-925μg/l). Nutritional needs were estimated using the following formulas; 22-25 kcal/kg ideal body weight (IBW)/d and 1.5-2.0 g protein/kg IBW/d, 30-35 ml IVF/kg /d. The patient’s input/output, body weight, and clinical status were monitored. Parenteral nutrition additive copper 0.3 mg/day and oral copper 8 mg daily, resulted in the rapid correction of hematologic indices over one week. Combined multivitamins supplementation and oral copper supplements alone normalized serum copper levels over 4 weeks and resulted in resolution of weakness and body edema. This report serves to alert physicians of the association between bariatric surgeries and subsequent severe copper deficiency in order to avoid diagnostic delays and to improve treatment outcomes.
机译：铜是许多酶促反应中至关重要的辅助因子，其血液学，血管，骨骼，抗氧化和神经系统的正常功能。肠外营养和慢性管饲料用于各种不吸收综合征，包括以下胃切除术和胃旁路手术。铜缺乏的特征包括血液异常异常（贫血，中性粒细胞病和白细胞病）和骨髓病变;后者是一种稀有，并且经常无法识别铜缺乏的并发症。我们描述了一名36名旧的埃米利蒂女性，因为普遍的身体弱点和疲劳后嗜酸术手术，被提到内分泌服务。患者最初注意到双侧肿胀的下肢肿胀，随着时间的推移，严重程度恶化并屈服于膝盖。超过3个月的时间，她逐渐恶化的能力。她还注意到两个胫骨上的marubopapular皮疹。患者在2011年患有袖子胃切除术。随后在2018年将袖子转化为2018年的RygB手术。众所周知患者对甲状腺素有良好控制的甲状腺功能亢进。她被规定的维生素D，神经炎，铁和多种维生素片手术后手术，但从未符合符合要求。由于在入院前的过去5个月内，由于口服差，患者被严重营养不良。在手术后不到9个月的情况下，她总体重减轻是34.5千克（重量率32％，BMI 28.52kg / m 2）。初始实验室揭示了严重的低恶蛋白血症，促核血症和中性血症。铁，叶酸，硫胺素和维生素B12水平正常。维生素B6水平为正常为11 mcg / L（正常= 5-50mcg / L）。血清铜水平低310μg/ L（正常=794-2023μg/ L）。锌水平低447μg/ L（正常=551-925μg/ L）。使用以下公式估算营养需求; 22-25 kcal / kg理想体重（Ibw）/ d和1.5-2.0g蛋白/ kg ibw / d，30-35ml IVf / kg / d。监测患者的输入/输出，体重和临床状态。肠外营养添加剂铜0.3毫克/天和口服铜8毫克，导致血液学指数快速矫正一周。组合多种维生素补充剂和口服铜补充剂在4周内单独归一化血清铜水平，导致解决虚弱和身体水肿。本报告有助于提醒医生慢性手术和随后的严重铜缺乏的医生，以避免诊断延误并改善治疗结果。

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