Daily Energy Requirements and Substrate Utilization in Hyper- and Hypometabolism of Obese COVID-19 Patients Measured by Indirect Calorimetry: Two Case Reports

Abstract

Despite the belief that critically ill obese patients with coronavirus disease 2019 have an increased resting energy expenditure (REE), in some specific obese patients, an apparently contradictory reduction in metabolic needs can be observed. A case report of two obese patients with diagnosis of COVID-19 admitted to an intensive care unit was conducted to illustrate this discrepancy. Case 1 is a 16-year-old female (body mass index (BMI) = 44.6 kg/m 2 ), with a medical history of clinical hypothyroidism, who had a remarkable decrease in REE. Case 2 is a 42-year-old male (BMI = 36.6 kg/m 2 ), with a medical history of polytrauma followed by a motorcycle accident showed a classical pattern of hypermetabolism. Indirect calorimetry (IC) was performed during 8 consecutive days for both patients. The different REE in the hypometabolic (case 1) and hypermetabolic (case 2) state was demonstrated by IC measurements. In conclusion, the more frequent usage of IC could avoid the pitfalls of predicting REE equations that could lead to an under or overfeeding.