PD236 - HOW ACUTE INTOXICATIONS RESHAPE ENERGY REQUIREMENTS: INSIGHTS FROM INDIRECT CALORIMETRY AND BIOELECTRICAL IMPEDANCE MONITORING

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PD236

HOW ACUTE INTOXICATIONS RESHAPE ENERGY REQUIREMENTS: INSIGHTS FROM INDIRECT CALORIMETRY AND BIOELECTRICAL IMPEDANCE MONITORING

L. I. Lovin1,2,*, C. Cobilinschi1,3, A. M. Dumitriu1,3, R. Darie1,2, I. M. Grințescu1,3, L. Mirea1,3, R. C. Țincu1,2

1Anesthesia and Intensive Care, Carol Davila University of Medicine and Pharmacy, 2ICU II Toxicology Clinic, 3ICU I Clinic, Clinical Emergency Hospital Bucharest, Bucharest, Romania

 

Rationale: Acute intoxications alter energy metabolism in substance-specific and unpredictable ways, exposing toxicology intensive care unit (TICU) patients to the risks of both underfeeding and overfeeding. Standard predictive equations fail to capture these shifts, making indirect calorimetry (IC) the only realiable tool for nutritional guidance.

Methods: Observational subgroup analysis of the ATTAINMENT trial (NCT06510348). Nine TICU patients (Clinical Emergency Hospital Bucharest, January–November 2025) with intoxications from benzodiazepines, opioids, lead, metformin, or neuroleptics underwent serial IC and bioelectrical impedance analysis over 15 days from admission. Mean measured resting energy expenditure (IC-REE) was compared to Harris-Benedict (HB) and ESPEN 25 kcal/kg estimates using paired t-tests, Pearson correlation, and Bland-Altman analysis.

Results: The mean IC-REE was 1814.8 kcal/day (SD 491.5) vs. 1573.5 by HB (−241 kcal/day, −10.1%, p 0.048; LoA −849 to +367 kcal/day). HB fell within 10% of IC in only 2/9 patients. ESPEN 25 kcal/kg overestimated by +146 kcal/day. REE increased significantly from early (days 3–5) to late (days 8–15) monitoring (p 0.016), with a mean intra-patient CV of 13.7% (range 8.7–20.2%). Survivors had markedly higher pooled IC-REE than non-survivors (2331 vs. 1406 kcal/day). Substance-specific patterns were pronounced: lead was consistently hypometabolic (mean IC-REE 1088 kcal/day); BZD showed wide variability (1532–2472 kcal/day); opioids produced opposite metabolic responses by outcome (survivor 2475 vs. non-survivor 1239 kcal/day).

Conclusion: Energy expenditure varied substantially within patients across the 15 days. Serial IC monitoring revealed dynamic, substance-driven REE shifts that no predictive formula could anticipate, supporting ESPEN recommendations for IC-guided nutrition in critically ill patients.

Disclosure of Interest: None declared