Severe vitamin B6 intoxication after inappropriate supplementation with micronutrients following bariatric surgery

A 50-year old Caucasian woman was admitted to our hospital with intermittent diarrhoea, emesis and increasingly brown coloured skin, mainly in light exposed area, after biliopancreatic diversion for obesity treatment. Differential diagnoses such as adrenal insufficiency were ruled out but biochemical analysis demonstrated unusual high pyridoxine serum levels (vitamin B6). History revealed the intake of 300 mg of vitamin B6 per day over 6 months described by her general practitioner. All symptoms disappeared after discontinuation of vitamin B6 supplementation. Importantly, in contrast to many other vitamins and supplements, there is no evidence in the literature of the occurrence of vitamin B6 deficiency after bariatric surgery. Therefore, supplementation of vitamins and supplements in bariatric patients has to be carefully considered due to existing clinical guidelines, since uncritical over-supplementation of micronutrients might result in intoxication and serious illness as presented here.