39-year-old patient with a 3-year history of type 2 diabetes mellitus with poor metabolic control, thrombophilia due to prothrombin gene mutation, supermorbid obesity (body mass index [BMI] 52 kg).
She was being followed up in the endocrinology clinic since her diabetes was diagnosed.
As treatment, he was prescribed diet and physical exercise, premixed insulin in 2 doses, metformin, omega-3 fatty acids, fenofibrate and regular table.
The patient came to a private clinic for bariatric surgery and underwent a laparoscopic biliopancreatic diversion without cholecystectomy one month after the last bud of her UC, with postoperative course without relevant incidents.
The patient required hospitalization 10 months after surgery for lower limb edema secondary to protein malnutrition and aggravated by acute gastroenteritis.
She was admitted again to our department one month later due to persistent severe hypoalbuminemia.
Since surgery, she hadn't had any UC sprout.
She reported 2-3 semi-soft stools and denied vomiting or food intolerance.
He had stopped antidiabetic treatment and presented remission data according to the American Diabetes Association.
On physical examination, acceptable general condition with mucocutaneous BMI, blood pressure 99/62, heart rate 57 beats/minute, weight 63 kilograms (percentage of overweight lost 92.4%), height 1.61 kg.
Lower extremities with oedemas from fovea to knees
The laboratory tests at admission showed total proteins: 4.4 g/dl (normal range [RN] 6.4-8.3), albumin 1.4 g/dl (RN 3.4-5.0) and prealbumin 5 mg/dl.
The patient also had anemia without fecundity and hemoglobin 9.8 g/dl (RN 12.0-18.0).
With the diagnosis of severe protein-caloric malnutrition, treatment was initiated with hypercaloric and hyperproteic diet, also administering powdered protein modules (60 grams per day).
During her hospital stay, which lasted for 3 weeks, she remained stable and edema disappeared.
At discharge the patient had good general condition and analytical improvement of nutritional parameters.
Bone densitometry performed during admission was normal.
