Re: Help with post op bypass patient

[Guest guest]

I would definitely see if they are going to do a head CT/MRI to look for stroke especially if she had trouble with a DVT. From: [mailto: ] On Behalf Of Cheryl FrushourSent: Tuesday, March 27, 2012 11:44 AM Subject: Help with post op bypass patient Hi!I have a post op patient who had Gastric Bypass in November 2011. She had complications with N/V/D in January and was readmitted for hydration, EGD which found 2 marginal ulcers, and then a subsequent LUE DVT, and CDiff colitis. She now present with loss of memory, loss of balance, difficulty writing her name, and still was some nausea and vomiting, abd pain. The surgeon ordered labs all which were pretty unremarkable other than a K of 3.5 and some elevated LFT's and T Bili. He ordered an abd CT that is pending. Although a previos abd CT was negative. B12, iron, Folic acid were all normal, still waiting on serum thiamin. Just wondering if there is anything else I shoudl recommend as far as labs ? Or any other insights about this case? Thanks for your input,Cheryl Frushour, RD,LDN,CNSCCare Specialist Bariatric SurgeryMeritus HealthCheryl.Frushour@...

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[Guest guest]

I would begin treating for suspected thiamin deficiency even though results are not back yet. 100 mg thiamin IM or IV daily for 3-5 days. If she has been not getting food/vits in reliably thiamin deficiency can develop very quickly. Serum thiamin is also unreliable, plasma thiamin more reliable so may want to treat based on symptoms.

From: [mailto: ] On Behalf Of Cheryl FrushourSent: Tuesday, March 27, 2012 12:44 PM Subject: Help with post op bypass patient

Hi!

I have a post op patient who had Gastric Bypass in November 2011. She had complications with N/V/D in January and was readmitted for hydration, EGD which found 2 marginal ulcers, and then a subsequent LUE DVT, and CDiff colitis.

She now present with loss of memory, loss of balance, difficulty writing her name, and still was some nausea and vomiting, abd pain. The surgeon ordered labs all which were pretty unremarkable other than a K of 3.5 and some elevated LFT's and T Bili. He ordered an abd CT that is pending. Although a previos abd CT was negative. B12, iron, Folic acid were all normal, still waiting on serum thiamin.

Just wondering if there is anything else I shoudl recommend as far as labs ? Or any other insights about this case?

Thanks for your input,

Cheryl Frushour, RD,LDN,CNSC

Care Specialist Bariatric Surgery

Meritus Health

Cheryl.Frushour@...

[Guest guest]

Thanks for the help Diane and !

Update; Head CT was negative. Plasma thiamin was low and now feeling better with IV thiamin repletion.

From: Cheryl Frushour <cheryl.frushour@...>" " < > Sent: Tuesday, March 27, 2012 1:44 PMSubject: Help with post op bypass patient

Hi!

I have a post op patient who had Gastric Bypass in November 2011. She had complications with N/V/D in January and was readmitted for hydration, EGD which found 2 marginal ulcers, and then a subsequent LUE DVT, and CDiff colitis.

She now present with loss of memory, loss of balance, difficulty writing her name, and still was some nausea and vomiting, abd pain. The surgeon ordered labs all which were pretty unremarkable other than a K of 3.5 and some elevated LFT's and T Bili. He ordered an abd CT that is pending. Although a previos abd CT was negative. B12, iron, Folic acid were all normal, still waiting on serum thiamin.

Just wondering if there is anything else I shoudl recommend as far as labs ? Or any other insights about this case?

Thanks for your input,

Cheryl Frushour, RD,LDN,CNSC

Care Specialist Bariatric Surgery

Meritus Health

Cheryl.Frushour@...