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.