Nutritional Vulnerability in RYGB Unmasked by GLP-1 Therapy.

We report a case of life-threatening malnutrition and liver injury in a post-Roux-en-Y gastric bypass patient after initiation of semaglutide, who subsequently developed profound micronutrient deficiencies and acute liver injury requiring ICU care, parenteral nutrition, and endoscopic bypass reversal. This case highlights the potential "dual-hit" risk of GLP-1 receptor agonists in patients with altered gastrointestinal anatomy. Clinicians should closely monitor nutritional status and liver function in postbariatric patients on GLP-1 therapy. Future research should explore safe prescribing practices, risk stratification, and the role of endoscopic interventions in managing severe complications.