title: Symptomatic vitamin A deficiency following biliopancreatic diversion.
abstract: BACKGROUND
  Biliopancreatic diversion (BPD) is an effective operation for morbid obesity. Fat-soluble vitamin deficiencies are known complications of this procedure, with incidence rates reported as high as 6%.
  
  
  METHODS
  A-36-year old morbidly obese female with BMI 60.6 kg/m(2) underwent laparoscopic adjustable gastric banding, followed 2 years later by BPD in an attempt to control her weight. Following BPD, she failed to attend outpatient appointments and was poorly compliant with daily multivitamins and monitoring of serum vitamin and mineral levels. She developed symptomatic vitamin A deficiency, with vitamin A levels <0.1 micromol/L, and night blindness, as well as deficiencies of vitamins D, E and K, zinc and selenium. Her vitamin deficiencies were corrected with appropriate supplements and her night blindness resolved.
  
  
  CONCLUSIONS
  This case raises the issues of preoperative screening of patients and compliance, as well as life-long postoperative monitoring of serum vitamin and mineral levels. With better compliance with outpatient appointments, prescribed multivitamins and oral vitamin A tablets, as well as regular monitoring of serum vitamin and mineral levels, vitamin deficiencies and their consequences, such as night blindness, may be avoided.
authors.affiliation: Department of Surgery, Royal Brisbane Hospital, Herston, Queensland, Australia. michaelhatzifotis@bigpond.com.au
authors.forename: Michael
authors.initials: M
authors.lastname: Hatizifotis
authors.forename: Kevin
authors.initials: K
authors.lastname: Dolan
authors.forename: Leanne
authors.initials: L
authors.lastname: Newbury
authors.forename: George
authors.initials: G
authors.lastname: Fielding
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D016312:Treatment Refusal; D014801:Vitamin A / Q000627:therapeutic use; D014802:Vitamin A Deficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D014801:Vitamin A