Are injection vitamin K (phytonadione) 10 mg IV once daily, injection thiamine (thiamine hydrochloride) 200 mg IV once daily, vitamin A chewable 50,000 IU daily, calcium‑vitamin D (Shelcal XT – calcium carbonate and vitamin D3) daily, vitamin C chewable (Limcee – ascorbic acid) 500 mg daily, antioxidant capsule daily, and vitamin E capsule (Evion – alpha‑tocopherol) 200 IU daily sufficient for a patient with significant malabsorption or postoperative nutritional requirements?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 19, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Vitamin and Mineral Supplementation Adequacy Assessment

Direct Answer

Your current regimen is inadequate and contains several critical gaps that place the patient at risk for serious deficiency-related complications, particularly if this is for malabsorptive bariatric surgery or significant malabsorption. The most concerning deficiencies are the complete absence of vitamin B12 supplementation, insufficient vitamin D dosing, suboptimal calcium formulation, and missing essential micronutrients like zinc and copper 1.

Critical Missing Components

Vitamin B12 (Completely Absent)

  • Vitamin B12 supplementation is mandatory after malabsorptive procedures and most bariatric surgeries, with recommended doses of 250-350 mg daily or 1000 mg weekly 1.
  • Neurological complications from B12 deficiency include numbness, tingling, disrupted coordination, and paralysis in severe cases 1.
  • Deficiency can occur even when serum levels appear adequate (>300 pmol/L), requiring additional testing with methylmalonic acid or holotranscobalamin if clinical suspicion exists 1.

Folic Acid (Missing)

  • Folic acid deficiency commonly occurs alongside B12 deficiency and can cause megaloblastic anemia 1.
  • This is particularly critical for women of childbearing age due to risks of neural tube defects and growth retardation 1.
  • Should be included in a comprehensive multivitamin formulation 1.

Zinc and Copper (Missing)

  • Zinc supplementation of at least 15 mg daily is recommended after restrictive procedures, and 30 mg daily after malabsorptive procedures 1.
  • Copper supplementation of 2 mg daily is essential, as zinc can interfere with copper absorption 1.
  • Deficiencies manifest as unexplained anemia, hair loss, changes in taste, and poor wound healing 1.

Inadequate Dosing of Current Supplements

Vitamin D (Severely Underdosed)

  • Your regimen contains vitamin D only through Shelcal XT (typically 200-400 IU), which is grossly insufficient 1.
  • Minimum recommended dose is 2000-4000 IU daily after restrictive procedures, with higher doses required after malabsorptive procedures 1.
  • Target serum 25-hydroxyvitamin D levels should be ≥75 nmol/L (≥30 ng/mL) 1.
  • Doses ≥2000 IU daily are significantly more effective at preventing postoperative hypovitaminosis D compared to lower doses 1.

Calcium (Wrong Formulation)

  • Shelcal XT contains calcium carbonate, which requires gastric acid for absorption 1.
  • Calcium citrate is strongly preferred after bariatric surgery because absorption is independent of stomach acidity 1.
  • Total elemental calcium should be 1200-2400 mg daily, divided into multiple doses for optimal absorption 1.

Vitamin A (Potentially Excessive for Some, Inadequate for Others)

  • 50,000 IU daily is appropriate for malabsorptive procedures like BPD/DS 1.
  • However, for restrictive procedures (sleeve gastrectomy, gastric bypass), the recommended starting dose is 10,000 IU daily 1.
  • Clarify the surgical procedure to determine appropriate dosing, as excessive vitamin A can cause toxicity 1.

Appropriate Components (But Context-Dependent)

Vitamin K

  • 10 mg IV daily is reasonable for acute treatment, but long-term supplementation should be oral 1.
  • Recommended maintenance dose is 300 μg oral daily after malabsorptive procedures 1.
  • IV administration is typically reserved for documented deficiency or coagulopathy 1.

Thiamine

  • 200 mg IV daily is appropriate for acute treatment in patients with vomiting, poor intake, or rapid weight loss 1.
  • However, oral thiamine 200-300 mg daily or vitamin B complex should be used for maintenance 1.
  • IV thiamine should not be prolonged unnecessarily; transition to oral once acute risk factors resolve 1.

Vitamin C (Limcee 500 mg)

  • This dose is adequate for general supplementation 1.
  • Vitamin C enhances iron absorption, which is beneficial if iron deficiency is present 2.
  • However, patients with hemochromatosis or iron overload must avoid vitamin C supplements entirely 2.

Vitamin E (Evion 200 IU)

  • 200 IU daily exceeds the recommended 100 IU starting dose for malabsorptive procedures 1.
  • This is acceptable but may be excessive for restrictive procedures where routine supplementation is not always necessary 1.

Antioxidant Capsule

  • Composition is unclear, but if it contains selenium, this is beneficial 1.
  • Selenium supplementation is recommended after malabsorptive procedures and RYGB 1.

Essential Additions Required

Comprehensive Multivitamin-Mineral Supplement

  • 1-2 complete multivitamin-mineral supplements daily are foundational and should contain at minimum: thiamine, B12, folate, iron, zinc, copper, selenium, and fat-soluble vitamins 1.
  • This provides baseline coverage for micronutrients not individually supplemented 1.

Iron Supplementation (If Indicated)

  • Iron deficiency is extremely common after bariatric surgery, particularly in menstruating women 3, 4.
  • If iron supplementation is needed, take with vitamin C (already included in your regimen) to enhance absorption 2.
  • Avoid taking iron simultaneously with calcium, as calcium inhibits iron absorption 2.

Monitoring Requirements

Immediate Laboratory Assessment Needed

  • Check vitamin B12, folate, zinc, copper, selenium, 25-hydroxyvitamin D, calcium, PTH, and complete blood count 1.
  • Monitoring should occur at 3,6, and 12 months postoperatively, then at least annually 1.
  • Do not wait for symptoms to develop before checking levels, as neurological damage from B12 deficiency may be irreversible 1.

Critical Clinical Pitfalls to Avoid

Do Not Assume IV Route is Superior for All Vitamins

  • While IV administration bypasses malabsorption, oral supplementation is preferred for long-term maintenance except in cases of documented severe malabsorption or intolerance 1.
  • Water-miscible forms of fat-soluble vitamins may improve oral absorption after malabsorptive procedures 1.

Do Not Use Calcium Carbonate After Bariatric Surgery

  • The reduced gastric acid environment severely impairs calcium carbonate absorption 1.
  • Switch to calcium citrate immediately 1.

Do Not Delay Thiamine Treatment if Clinical Suspicion Exists

  • If the patient has rapid weight loss, vomiting, or neurological symptoms, initiate thiamine treatment immediately without waiting for laboratory confirmation 1.
  • Giving glucose before thiamine repletion can precipitate Wernicke's encephalopathy 1.

Recommended Revised Regimen

For malabsorptive bariatric surgery (BPD/DS, RYGB):

  • Comprehensive multivitamin-mineral supplement: 1-2 tablets daily 1
  • Vitamin B12: 350 mg daily oral or 1000 mg weekly IM 1
  • Calcium citrate: 1200-2400 mg elemental calcium daily (divided doses) 1
  • Vitamin D3: 3000-4000 IU daily (titrate to serum levels ≥75 nmol/L) 1
  • Vitamin A: 10,000 IU daily (adjust based on levels) 1
  • Vitamin E: 100 IU daily 1
  • Vitamin K: 300 μg oral daily 1
  • Thiamine: 200-300 mg oral daily (or B-complex) for first 3-4 months 1
  • Zinc: 30 mg daily 1
  • Copper: 2 mg daily 1
  • Vitamin C: 500 mg daily 1
  • Iron: As needed based on labs, with vitamin C 2

For restrictive procedures (sleeve gastrectomy):

  • Similar regimen but lower doses of vitamin A (10,000 IU), zinc (15 mg), and vitamin D (2000 IU minimum) 1.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Vitamin C and Iron Absorption

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Research

Nutritional management of patients after bariatric surgery.

The American journal of the medical sciences, 2006

4
Research

Nutritional and metabolic complications of bariatric surgery.

The American journal of the medical sciences, 2006

Related Questions

What are the next steps for a patient who has completed their prescription treatment, shows no psychological symptoms, but remains underweight at 80 pounds?
What is the best next step for managing weight loss in an elderly patient with significant weight loss, low BMI, anemia, and impaired renal function?
How to manage post-bypass surgery patients with aversion to eating?
What lab monitoring is recommended for patients after bariatric surgery?
What is the most appropriate dietary modification for a patient with a history of gastric bypass surgery presenting with fatigue, numbness of hands and feet, diarrhea, loss of appetite, and sore tongue, with elevated methylmalonic acid and homocysteine levels?
Should a patient with severe obstructive jaundice from a peri‑ampullary tumor undergoing biliary drainage before pancreaticoduodenectomy receive ursodeoxycholic acid (UDCA)?
Is maitake mushroom (Grifola frondosa) supplementation safe in healthy adults, and what dosing and contraindications should be considered?
What is the appropriate starting dose of insulin glargine (glargine) for an adult postoperative surgical patient?
How do I assess severity and choose appropriate antibiotic therapy for a patient with suspected community‑acquired pneumonia?
What unfractionated heparin (UFH) bolus dose and continuous infusion rate should be used in an adult patient (~70 kg) with acute arterial occlusion and no major contraindications?
Can I take ibuprofen together with cyclobenzaprine (Flexeril)?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question