{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T16:59:47Z","timestamp":1757609987222,"version":"3.44.0"},"reference-count":10,"publisher":"SMC Media","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Bariatric surgery has emerged as a highly effective treatment option for individuals with obesity. Severe hypoalbuminaemia is a feared complication after a Roux-en-Y gastric bypass. It is characterised by a low serum albumin level of &lt;25 g\/l, neither explained by renal losses, protein-losing enteropathy nor by liver disfunction, and is associated with high morbidity and mortality. Prompt workup leading to the diagnosis and aggressive treatment are recommended to prevent rapid clinical worsening; however, evidence-based recommendations and specific treatment approach are lacking. Most cases can be managed with dietary counselling and protein-enhanced oral supplements. We report a case of a female patient in her 50s with class II obesity, who underwent a Roux-en-Y gastric bypass eight months earlier, who presented to the Emergency Department with new onset of asthenia and lower limb oedema. Her biochemistry panel revealed severe serum hypoalbuminaemia, with a level of 18.4 g\/l. After a thorough examination, complete laboratory tests and imaging that excluded renal and gastrointestinal losses and hepatic disfunction, she was presumed to have developed severe hypoalbuminemia after bariatric intervention. She managed to increase her oral intake of protein-enhanced products, according to nutritional counselling. At a six-month follow-up visit the patient regained 1% of the weight and had a slow and progressive increase in the serum albumin level. Our report highlights the importance of continuous nutritional monitoring and a multidisciplinary approach in the post-operative period of bariatric surgery to improve long-term outcomes.<\/jats:p>","DOI":"10.12890\/2025_005741","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T14:25:16Z","timestamp":1756131916000},"source":"Crossref","is-referenced-by-count":0,"title":["Severe hypoalbuminaemia after Roux-en-Y gastric bypass: a diagnosis of exclusion"],"prefix":"10.12890","volume":"12","author":[{"given":"Catarina","family":"Santos Reis","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Filipa","family":"Lopes","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Santos Dias","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Soares Carreira","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Almeida","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"doi-asserted-by":"crossref","unstructured":"Ziegler O, Sirveaux MA, Brunaud L, Reibel N, Quilliot D. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab 2009;35:544\u2013557. doi: 10.1016\/S1262-3636(09)73464-0","key":"10.12890\/2025_005741_ref1","DOI":"10.1016\/S1262-3636(09)73464-0"},{"doi-asserted-by":"crossref","unstructured":"Mantziari S, Abboretti F, Favre L, Thomopoulos T, Barigou M, Demartines N, et al. Protein malnutrition after Roux-en-Y gastric bypass: a challenging case and scoping review of the literature. Surg Obes Relat Dis 2023;19:746\u2013754. doi: 10.1016\/j.soard.2022.12.032","key":"10.12890\/2025_005741_ref2","DOI":"10.1016\/j.soard.2022.12.032"},{"doi-asserted-by":"crossref","unstructured":"Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B . Bariatric surgery and long-term nutritional issues. 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Treatment of severe protein malnutrition after bariatric surgery. Obes Surg 2019;29:3095\u20133102. doi: 10.1007\/s11695-019-04035-8","key":"10.12890\/2025_005741_ref6","DOI":"10.1007\/s11695-019-04035-8"},{"doi-asserted-by":"crossref","unstructured":"Rubino F, Cummings DE, Eckel RH, Cohen RV, Wilding JPH, Brown WA, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol 2025;13:221\u2013262. doi: 10.1016\/S2213-8587(24)00316-4. Erratum in: Lancet Diabetes Endocrinol 2025;13:e6. doi: 10.1016\/S2213-8587(25)00006-3","key":"10.12890\/2025_005741_ref7","DOI":"10.1016\/S2213-8587(25)00006-3"},{"doi-asserted-by":"crossref","unstructured":"Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med 2017;376:254\u2013266. doi: 10.1056\/NEJMra1514009","key":"10.12890\/2025_005741_ref8","DOI":"10.1056\/NEJMra1514009"},{"doi-asserted-by":"crossref","unstructured":"McLean C, Mocanu V, Birch DW, Karmali S, Switzer NJ. Hypoalbuminemia predicts serious complications following elective bariatric surgery. Obes Surg 2021;31:4519\u20134527. doi: 10.1007\/s11695-021-05641-1","key":"10.12890\/2025_005741_ref9","DOI":"10.1007\/s11695-021-05641-1"},{"doi-asserted-by":"crossref","unstructured":"Fieber JH, Sharoky CE, Wirtalla C, Williams NN, Dempsey DT, Kelz RR. The malnourished patient with obesity: a unique paradox in bariatric surgery. 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