Nutritional and pharmacologic challenges in the bariatric surgery patient

The purpose of this study was to describe vitamin and nutrient supplement practices and assess medication dosage formulations utilized in patients hospitalized with a history of bariatric surgery. Retrospective pilot study was conducted from January 1, 2006 through December 31, 2007 in patients with a past history of bariatric surgery. Demographic data, vitamin and nutrient supplements, and medication dosage formulations were evaluated upon admission. This was compared to published guidelines. Compliance with the following supplementation was categorized: daily multivitamin, calcium, iron, vitamin B-12, and folic acid. The frequency of non-immediate-release and enteric-coated medication dosage forms was also examined. Discrepancies were identified as lack of one of the supplements or if an inappropriate dosage formulation was ordered. Of 133 admissions, 117 (88%) had a history of a malabsorptive procedure and at least one discrepancy was found. Only 33.3% of admissions were ordered a multivitamin, 5.1% were ordered supplemental vitamin B-12, and 7.7% received a calcium supplement. Additional folic acid was ordered in 11.1% and iron ordered in 12.0%. Inappropriate medication formulations were ordered in 61.5% of patients; 34.7% included non-immediate-release formulations, 25.0% enteric-coated formulations, and 40.3% both non-immediate-release and enteric-coated. Upon discharge from the institution, 50% had inappropriate formulations continued. Patients with a history of bariatric surgery may not have their vitamin and nutrient needs met upon hospitalization. Prior bariatric surgery is not consistently taken into consideration when ordering medications. Healthcare providers need to be cognizant of vitamin regimens to recommend as well as medication dosage formulations to avoid.