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Correction to Bonkovsky et al., N Engl J Med 358(26):2813-2825 June 26, 2008.

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Volume 359:1850-1852 October 23, 2008 Number 17
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Case 20-2008: Abdominal Pain and Weakness after Gastric Bypass Surgery

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by Bonkovsky, H. L.
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To the Editor: In the discussion of the Case Record by Bonkovsky et al. (June 26 issue)1 about a patient with porphyria who became symptomatic after gastric bypass surgery, there was no mention of the patient's nutritional care, which may have played a major contributory role. The persistent ketonuria before hospitalization indicates a daily carbohydrate intake of less than 100 g, whereas the very low serum creatinine level on admission indicates limited meat intake and a marked reduction in skeletal muscle, reflecting severe protein-calorie malnutrition.2 These findings are consistent with limited energy and protein intake postoperatively, which was at least . . . [Full Text of this Article]



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