From the Research
For vitamin A repletion in a patient with Roux-en-Y gastric bypass (RYGB) and a level of 35 μg/dL, I recommend 10,000-25,000 IU of vitamin A daily for 1-2 months, followed by reassessment of levels. This recommendation is based on the need to address the deficiency while considering the risks associated with excessive supplementation, as indicated by studies such as 1, which found a U-shaped association between serum vitamin A levels and mortality. The chosen dose and duration aim to efficiently replenish vitamin A stores without exceeding safe limits, especially considering the malabsorption issues in RYGB patients. Given the most recent evidence from 2, which highlights the association between low vitamin A levels and liver-related mortality, it's crucial to correct the deficiency to improve outcomes related to morbidity, mortality, and quality of life. The supplementation should be in a water-miscible or liquid form to enhance absorption, given the malabsorption of fat-soluble vitamins in RYGB patients. After reaching normal levels (typically 30-120 μg/dL), a maintenance dose of 5,000-10,000 IU daily or as part of a bariatric-specific multivitamin should be continued, with monitoring of vitamin A levels every 3-6 months initially, then annually once stable. It's also important to be cautious with high-dose supplementation in women of childbearing age due to teratogenicity risks and to address concurrent deficiencies, particularly zinc, as it is necessary for vitamin A metabolism and transport. Patients should be educated about potential symptoms of vitamin A deficiency, including night blindness, dry eyes, and poor wound healing, to ensure early detection of any recurrence of deficiency. This approach prioritizes the patient's morbidity, mortality, and quality of life outcomes, aligning with the most recent and highest quality evidence available, such as the findings from 2 and the general principles of vitamin A supplementation guided by studies like 1.