title: Neurologic dysfunction and pancytopenia secondary to acquired copper deficiency following duodenal switch: case report and review of the literature.
abstract: The duodenal switch (DS) procedure is a type of restrictive-malabsorptive bariatric surgery that is typically reserved for severe morbidly obese people (body mass index >50 kg/m(2)) with obesity-related comorbidities, when diet, lifestyle changes, and pharmacologic therapy fail to achieve adequate weight loss. Patients who undergo the DS procedure are at risk for malabsorption, malnutrition, and nutrient deficiencies. Copper deficiency is a commonly reported long-term complication of Roux-en-Y gastric bypass (RYGB) surgery. However, data are limited on copper deficiency-associated complications and their treatment in DS patients. This article presents a case of a patient who developed hypocupremia with associated pancytopenia, myeloneuropathy, and leukoencephalopathy following DS and reviews the literature related to the pathophysiology of copper deficiency and copper replacement in bariatric surgery patients. When severe diarrhea was present, intravenous elemental copper 4 mg (as cupric chloride)/d in addition to daily oral copper gluconate was necessary to correct the hypocupremia and improve the hematologic indices and neurologic symptoms of copper deficiency. When diarrhea subsided, oral elemental copper 4 mg (as copper gluconate) 3 times daily maintained normal serum copper concentrations and avoided the relapse of severe neurologic dysfunction. Regular monitoring of serum copper and ceruloplasmin concentrations is recommended following DS surgery to detect any copper deficiency before irreversible neurologic damage occurs. Long-term copper supplementation is likely necessary to maintain normal copper status in DS patients.
authors.affiliation: Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan 48109-0008, USA. imadb@umich.edu
authors.forename: Imad F
authors.initials: IF
authors.lastname: Btaiche
authors.forename: Alice Y
authors.initials: AY
authors.lastname: Yeh
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Wu
authors.forename: Nabil
authors.initials: N
authors.lastname: Khalidi
mesh_terms: D003300:Copper / Q000097:blood / Q000172:deficiency* / Q000627:therapeutic use; D003677:Deficiency Diseases / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D003967:Diarrhea / Q000209:etiology; D004386:Duodenum / Q000601:surgery; D015390:Gastric Bypass; D005942:Gluconates / Q000627:therapeutic use; D006405:Hematology; D006801:Humans; D056784:Leukoencephalopathies / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D010198:Pancytopenia / Q000209:etiology*; D011183:Postoperative Complications / Q000097:blood
chemical_list: D005942:Gluconates; D003300:Copper