Indirect Calorimetry &
Metabolic Energy Profiler
Professional REE and energy-target estimation for qualified nutrition practice - Weir equation (full IC & VCO₂-only ICU mode), ICMR-NIN 2020 Indian adult adjustment, Henry Oxford, Mifflin-St Jeor, and Schofield Pediatric.
Patient and care setting
Start with where the patient is being treated and what metabolic data are available today.
Anthropometry and weight history
Review every relevant weight and make the dosing basis explicit.
Metabolic measurement
The fields below adapt to the pathway selected above.
Clinical modifiers
Add only the conditions that change interpretation, protein or feeding progression.
Current nutrition delivery
Compare documented 24-hour energy and protein with today’s prescription.
Review and calculate
Confirm the pathway, dosing weights and any missing required data.
Recorded only to select the sex-specific equation coefficient; document gender identity separately in the clinical record where relevant.
Indian adult adjustment: ICMR-NIN 2020 uses lower adult BMR estimates because international equations may overestimate BMR in Indian populations. The exact formula is shown in results.
ICMR India PAL values differ from WHO: sedentary = 1.40 (not 1.20).
If lean body mass (LBM/FFM) has been measured by a valid method - DEXA or quality-controlled BIA - Cunningham and Katch-McArdle may improve the relevance of predicted REE. A Boer estimate may be shown for reference, but it does not activate or silently replace a measured-LBM equation.
Direct entry - unlocks Cunningham & Katch-McArdle.
Auto-computes LBM if weight entered in Patient Details.
Clinical dosing weight differs by scenario. Actual weight suits most patients; ideal/adjusted are used in obesity; dry (euvolemic) weight is preferred where fluid overload, oedema, ascites, or dialysis inflate measured weight. The chosen basis drives the protein prescription.
Post-dialysis / true euvolemic weight. Recommended dosing basis for dialysis, oedema, ascites, or fluid overload.
“Auto” follows guideline logic (e.g. IBW for ICU obesity). Override when fluid status or body habitus warrants a different basis. Applies to protein; energy equations retain their guideline weight.
Most users start with Predictive — no gas data needed. Choose Full IC, VCO₂-only, or VO₂-only only if you have metabolic-cart or ventilator gas-exchange values.
Enter both VO₂ and VCO₂ to activate the Abbreviated Weir equation. This is the reference method when performed under valid measurement conditions and overrides predictive equations. Add urinary nitrogen for complete Weir.
Formula Method
Physiological rest range: 0.10–0.40 L/min (ICU). Values outside warrant verification.
RQ = VCO₂ ÷ VO₂. Expected resting RQ: 0.70–1.00; review if outside this band; critical validity warning below 0.67 or above 1.30.
24-hr urine nitrogen. Abbreviated Weir used if omitted (<1–3% error).
Use when ventilator capnometer data is available but a full IC metabolic cart is not. The REE multiplier is computed live from the assumed RQ - the familiar ×8.19 corresponds to RQ ≈ 0.86, not 0.85. Prefer this over predictive equations for mechanically ventilated patients when full IC is unavailable.
Formula Method
Enter in mL/min (typical ICU adult 100–300). This method is generally more accurate than predictive equations but less accurate than full IC; the individual error cannot be assumed from a population average.
Default 0.86 → multiplier ≈ ×8.19 (canonical). At RQ 0.85 the multiplier is ≈ ×8.27. Measured RQ requires both VO₂ and VCO₂ — use Full IC mode if both are available. Expected resting range 0.70–1.00.
Use when only VO₂ is measurable (VCO₂ sensor unavailable or unreliable). REE estimated via assumed RQ. Accuracy lower than full IC - use as interim until VCO₂ data is available.
Formula Method
VO₂-only estimate: first estimate VCO₂ from assumed RQ, then run the abbreviated Weir equation. Lower confidence than full IC or ventilator-derived VCO₂.
Default 0.85 (mixed substrate). Adjust based on clinical context.
No IC gas data entered. REE will be calculated using predictive equations based on demographics and body composition (Patient Details & Body Composition tabs). Configure the equation and context settings there.
ESPEN ICU Nutrition Guideline 2023: predictive equations may be substantially inaccurate in critical illness. Consider IC measurement for ICU patients.
Interface affects gas-exchange accuracy: ECMO and NIV carry highest error risk. Canopy is preferred for spontaneously breathing ICU patients.
Document the analysed interval. Accept either 5–24 minutes with VO₂/VCO₂ CV ≤5%, or ≥25 minutes with CV ≤10%.
Use the device manufacturer’s calibration or verification procedure. A failed check invalidates gas-derived results.
Required for Full IC validity: ≤5% for a 5–24 minute interval or ≤10% for ≥25 minutes.
Use the same duration-dependent criterion as VO₂.
Room air = 0.21. The valid upper FiO₂ depends on the device, sampling method, and manufacturer specification.
Enter the upper limit from the metabolic cart instructions for use or local validation. No universal limit is assumed.
A recorded “yes” should be supported by the entered duration and CV values.
A confirmed leak invalidates gas-exchange values. VCO₂-only is not a safe fallback if the same leaking circuit produced the VCO₂.
Protocol disturbance checklist optional · generates flags
Tick any disturbances that occurred during or within 30 min of measurement. Each checked item generates a clinical flag.
Used only for protein guardrails. CKD without dialysis should not auto-prescribe high protein; dialysis and CRRT have separate targets.
Applied to predicted REE only (Tier 3 equations). Automatically skipped for measured IC (Tier 1) and VCO₂-only (Tier 2) - multiplying a measured metabolic rate is clinically invalid. Use with caution even for predictive equations; direct IC measurement is always preferred in critical illness.
Add ward-round context, weight trend, current intake delivery, and the hospital protocol assumptions that must appear in the final report.
Optional hospital assessment fields. Dry weight is never estimated from oedema or ascites; enter only a clinically verified dry/euvolemic weight in Body Composition.
Enter only documented intake delivered in the same 24-hour period. Propofol and IV dextrose contribute energy but not protein.
Hospital / Clinical Protocol assumptions shown in report
Selecting “Local protocol” records the assumption; it does not silently replace formula coefficients. Use clinician overrides where provided and document the local rule.
Clinical Priority Cascade
Live Clinical Snapshot
-Formula, Inputs & Assumptions
All calculations run locally in your browser. No patient data is sent to any server. The downloadable report is generated on your device only.
Clinical Metabolic Assessment
Method, calculation logic, limitations, prescription, delivery, and documentation in one auditable view.
Complete the assessment workspace and calculate a metabolic profile.
Energy & Protein Prescription
The practical target after phase, condition, and dosing-weight logic.
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Weight & Body Composition
All relevant weights are visible; only the selected basis drives each prescription.
Weight Trend & Malnutrition Flags
Trend calculations support screening; they do not diagnose malnutrition alone.
Method & Validity Audit
The actual equation, substitutions, assumptions, and quality checks used.
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Protein prescription calculation
Anthropometry and dosing-weight calculations
Measurement validity evidence
Delivery arithmetic
Clinical Adjustments
Exactly how the clinical context changed interpretation.
Selected Protocols
Local assumptions remain visible for audit and handover.
Current Delivery vs Prescription
Documented 24-hour intake compared with the current clinical target.
08 Secondary calculations & equation comparison
Predictive equation comparison
Optional macro distribution
Documentation-ready Dietitian Note
Generated locally from the same result object as this report.
Report generated locally. Not a prescription without clinician review.