losartan-potassium and Obesity--Morbid

Topics: Acetamides; Aged; Anemia, Refractory; Anemia, Sideroblastic; Anti-Bacterial Agents; Arthroplasty; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Combined Modality Therapy; Comorbidity; Diabetes Mellitus, Type 2; Diagnosis, Differential; Erythrocyte Transfusion; Erythropoietin; Female; Humans; Linezolid; Methicillin-Resistant Staphylococcus aureus; Obesity, Morbid; Oxazolidinones; Polypharmacy; Postoperative Complications; Prosthesis-Related Infections; Reoperation

A 38-year-old woman, obese (219 kg), diabetic, hypertensive, chronic kidney disease (CKD) stage 4, with low plasma albumin level (2.9 g dl(-1)) and marked proteinuria (22 g per day) was studied. Given the advanced-stage CKD with nephrotic proteinuria, we supplemented low-protein diet with high doses of a tailored essential amino acid mixture (AAs: 44 g per day) to improve weight reduction in the patient. After 20 months of conservative therapy, the patient lost 43 kg; despite two episodes of infection, albumin plasma levels increased up to 3.7 g per day. After a further 20 months of dialysis, the patient maintained a diet of 1800 kcal supplemented with 32 g of AAs and lost 47 kg, whereas both albumin (3.89±0.12 g dl(-1)) and C reactive protein returned to normal. During the follow-up period, anemia improved, erythropoietin was thus discontinued and insulin requirement decreased to 105 IU. This therapeutic option may be beneficial in advanced CKD patients with obesity and diabetes resulting from malnutrition.

Topics: Adult; Amino Acids, Essential; Amphetamine; Anemia; Body Mass Index; C-Reactive Protein; Diet, Protein-Restricted; Dietary Supplements; Energy Intake; Erythropoietin; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Hypertension; Obesity, Morbid; Patient Compliance; Proteinuria; Quality of Life; Renal Insufficiency, Chronic; Serum Albumin; Treatment Outcome; Waist Circumference

Iron deficiency in patients with morbid obesity can occur before bariatric surgery due to its inflammatory component and after surgery as the result of implementing the malabsorptive techniques. For patients with morbid obesity, micronutrient deficiencies, such as vitamin B12, iron and folate, should be suspected. Iron deficiency and other hematinics should be corrected, even when anemia has not been established. Normal ferritin levels do not allow us to rule out a possible iron deficiency, given that ferritin can increase due to the chronic inflammatory condition of obesity. After bariatric surgery, patients should take iron supplements; however, these supplements are frequently poorly tolerated. Rapid and effective correction of hemoglobin levels might require the intravenous administration of iron preparations.

Topics: Anemia; Bariatric Surgery; Blood Loss, Surgical; Blood Transfusion; Erythropoietin; Female; Hematinics; Hemoglobins; Humans; Iron; Male; Medical Errors; Obesity, Morbid; Practice Guidelines as Topic; Preoperative Care; Recombinant Proteins; Risk Factors