Hypermetabolism and COVID‐19, 2020, Yu et al

[Andy]

Background

Hypermetabolism has been described in stress states such as trauma, sepsis, ARDS, and severe burn injuries. We hypothesize that patients with COVID‐19 may develop a hypermetabolic state which may be a major contributing factor to the extraordinary ventilatory and oxygenation demands in patients with COVID‐19.

Method
Resting energy expenditure (REE), carbon dioxide production (VCO2) and oxygen consumption (VO2) were measured by indirect calorimetry on seven critically ill patients with COVID‐19.

Results
The median measured REE was 4044 Kcal/day which was 235.7% ± 51.7% of predicted. The median VCO2 was 452 mL/min (range 295–582 mL/min) and the median VO2 was 585 mL/min (range 416–798 mL/min).

Conclusion
Critically ill patients with COVID‐19 are in an extreme hypermetabolic state. This may explain the high failure rates for mechanical ventilation for these patients and highlights the potential need for increased nutritional requirements for such patients.

Paywall, https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1948
Sci hub, https://sci-hub.tw/10.1002/jpen.1948

 

[rvallee]

The median measured REE was 4044 Kcal/day which was 235.7% ± 51.7% of predicted

I'm sorry what? They have ~230% the base metabolic rate?

No wonder so many are experiencing weight loss. Wow.

And yeah supplemental nutrition sounds about right. Very interesting.

 

[alktipping]

isn't it common sense that people with fevers are burning more calories ie to produce enough heat to kill of invading bacteria or virus . even grannies used to say starve a cold and feed a fever . hospital nutritionist should already know this.

 

[Trish]

isn't it common sense that people with fevers are burning more calories ie to produce enough heat to kill of invading bacteria or virus . even grannies used to say starve a cold and feed a fever . hospital nutritionist should already know this.

I thought the old saying was feed a cold and starve a fever. And probably not medically useful advice. It sounds like this hyper metabolism in critically ill Covid patients is much more than normal in infections.

 

[Ebb Tide]

I used to work in later stage rehabilitation of people with severe traumatic brain injury.

Although I never worked with patients in the acute phase, when they were on ventilators in induced coma, my memory is that they needed nutritional input of around 5000Kcal/day because of the extent of the trauma and the body's efforts of responding to that.

Sorry, don't have a reference.

When I first went into the field over 30 years ago, until it was well understood that in spite of being immobile, patients could have such high energy demands, some patients could end up malnourished.