Answer to Question 1
BMI: 703 x 191 lbs./65 in./65 in.= 31.8 or 32 . This classifies her as obese.
IBW: 100 + (5 in.) x (5 lbs.) = 125 lbs.
IBW: 191 lbs./125 lbs. x 100 = 153 of IBW
Answer to Question 2
While the two equations produced similar caloric needs (2600 kcal), the metabolic cart showed that he needed closer to 3600 kcal. There could be multiple reasons for this discrepancy. On the one hand, indirect calorimetry has many opportunities for error including system leaks when the seal around the mask is not tight enough, discrepancies in the equation used to calculate VO2 max, and the inability to keep a patient in a steady-state while conducting the test. These along with the fact that the abdominal drains may allow metabolically produced carbon dioxide to leak out all contribute to the possible error in the indirect calorimetry measurement. However, the equations are not completely accurate either, as they account for trauma, but are not very specific to his condition. The predictive equations require a healthy mix of science, experience, and art to properly assign the patient to their required needs. That is to say that deciding on the appropriate injury factor or proper range based upon nomograms (e.g. 25-30 kcal/kg vs. 30-35 kcal/kg) provides room for interpretation and professional judgement.
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