PD288 - FROM SLEEVE TO ICU: POST-ICU SYNDROME FOLLOWING HYPERNATREMIC COMADUE TO SEVERE POST-BARIATRIC MALNUTRITION: A CASE REPORT

PD288

FROM SLEEVE TO ICU: POST-ICU SYNDROME FOLLOWING HYPERNATREMIC COMA

DUE TO SEVERE POST-BARIATRIC MALNUTRITION: A CASE REPORT

A. A. Alfarraj^1,2,*

¹Department of Clinical Nutrition, King Saud Medical City, Riyadh First Health Cluster , ²Department of Community Health Sciences, King Saud University , Riyadh , Saudi Arabia

Rationale: Nutritional deficiencies affect up to 61% of  Sleeve Gastrectomy (SG) patients within 3 years, yet postoperative dietitian surveillance is often lacking. Gastric stenosis complicates 1-4% of SG cases and can cause life-threatening complications when oral intake fails. Post-ICU Syndrome (PICS) impacts >54% of ICU survivors but is rarely reported post-bariatric. To our knowledge, the co-occurrence of hypernatremic coma, recurrent SG stenosis, and PICS as a unified nutritional collapse has not been previously described.

Methods: A 37-year-old male with severe malnutrition 5 weeks post-SG with no dietitian follow-up. The review included the clinical course, laboratory data, endoscopic findings, and nutritional interventions from 3 admissions and 12 months of outpatient records.

Results: Hypernatremic coma (Na⁺ 199 mmol/L), Acute Kidney Injury (AKI) (creatinine 706 µmol/L), and rhabdomyolysis required ventilation, CRRT, and tracheostomy over 53 ICU days. Endoscopy confirmed SG stenosis; NGT placed under guidewire. Enteral nutrition started at 10 mL/hr given refeeding risk (phosphate nadir 0.59 mmol/L). Two admissions addressed recurrent hypernatremia and stenosis via balloon dilatation and nasojejunal tube, bridged by parenteral nutrition. Polyneuropathy, thrombocytopenia, and anemia confirmed PICS. Weekly-to-biweekly dietitian contacts over 6 months achieved oral high-protein diet transition; weight stabilized at 92 kg at 1 year (pre-op: 165 kg).

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Conclusion: Absence of post-bariatric dietitian surveillance precipitated a catastrophic, multi-admission nutritional crisis consistent with PICS. Integration of clinical dietitians into mandatory post-bariatric protocols is essential to prevent ICU-level nutritional collapse.

References: Steenackers et al. (2023).Nutritional deficiencies after bariatric surgery. Nutr Res Rev, 36(2), 512–525

Disclosure of Interest: None declared