The obese patient - Revision history

Danbot: Strip excess bold

2026-03-22T09:38:11Z

Strip excess bold

← Revisión anterior		Revisión del 09:38 22 mar 2026
Línea 6:		Línea 6:

	==Dosing Scalars==		==Dosing Scalars==
	*Total body weight ~~'''~~(TBW)~~'''~~= Actual weight		*Total body weight (TBW)= Actual weight
	**May result in over dosing		**May result in over dosing
	*[[ideal body weight estimation\|Ideal body weight]] ~~'''~~(IBW)~~'''~~= Calc. based on height & weight		*[[ideal body weight estimation\|Ideal body weight]] (IBW)= Calc. based on height & weight
	**May result in under dosing		**May result in under dosing
	*Lean body weight ~~'''~~(LBW)~~'''~~= Difference between TBW and fat mass<br>		*Lean body weight (LBW)= Difference between TBW and fat mass<br>
	**Technically best weight scalar for drug administration but difficult to accurately measure		**Technically best weight scalar for drug administration but difficult to accurately measure
	*Adjusted body weight (ABW) = Scalar derived from aminoglycoside pharmacokinetics (PK) in obesity		*Adjusted body weight (ABW) = Scalar derived from aminoglycoside pharmacokinetics (PK) in obesity
Línea 17:		Línea 17:
	''There are multiple formulas to estimate weight - these are the most common:''		''There are multiple formulas to estimate weight - these are the most common:''

	*~~'''~~Estimated male TBW~~'''~~ = 93.2 + 3.29[arm circumference (cm)] + 0.43[height (cm)]		*Estimated male TBW = 93.2 + 3.29[arm circumference (cm)] + 0.43[height (cm)]
	*~~'''~~Estimated female TBW~~'''~~ = 64.6 + 2.15[arm circumference (cm)] + 0.54[height (cm)]		*Estimated female TBW = 64.6 + 2.15[arm circumference (cm)] + 0.54[height (cm)]
	*~~'''~~Estimated male IBW in kg~~'''~~ = height in cm - 100		*Estimated male IBW in kg = height in cm - 100
	**More accurate IBW estimate:		**More accurate IBW estimate:
	***IBW (male) in kg = 50kg + 2.3kg for each in. over 5ft		***IBW (male) in kg = 50kg + 2.3kg for each in. over 5ft
	*~~'''~~Estimated female IBW in kg~~'''~~ = height in cm - 105		*Estimated female IBW in kg = height in cm - 105
	**More accurate IBW estimate:		**More accurate IBW estimate:
	***IBW (female) in kg = 45kg + 2.3kg for each in. over 5ft		***IBW (female) in kg = 45kg + 2.3kg for each in. over 5ft
	*~~'''~~Estimated LBW~~'''~~ = 1.3 x IBW		*Estimated LBW = 1.3 x IBW
	*~~'''~~Estimated ABW~~'''~~ = IBW + [C x(TBW-IBW)]		*Estimated ABW = IBW + [C x(TBW-IBW)]
	**C = correction factor ususally 0.2 to 0.4		**C = correction factor ususally 0.2 to 0.4
	*Apps/Online resources:		*Apps/Online resources:

Danbot: Move calculators to own section with header (visible in TOC), expanded, before External Links

2026-03-21T15:06:05Z

Move calculators to own section with header (visible in TOC), expanded, before External Links

← Revisión anterior		Revisión del 15:06 21 mar 2026
Línea 100:		Línea 100:
	*Ultrasound may improve identification of landmarks		*Ultrasound may improve identification of landmarks
	*If failure, consider fluoroscopy-guided procedure by IR		*If failure, consider fluoroscopy-guided procedure by IR

			== Calculators ==
			{{BMI_Calculator}}

	==References==		==References==
	<references/>		<references/>


	~~<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">~~
	~~<div style="font-weight:bold;">📊 BMI / Body Surface Area Calculator [show]</div>~~
	~~<div class="mw-collapsible-content">~~
	~~{{BMI_Calculator}}~~
	~~</div>~~
	~~</div>~~
	[[Category:Misc/General]]		[[Category:Misc/General]]

Danbot: Add BMI / Body Surface Area calculator (collapsible)

2026-03-21T13:52:43Z

Add BMI / Body Surface Area calculator (collapsible)

← Revisión anterior		Revisión del 13:52 21 mar 2026
Línea 104:		Línea 104:
	<references/>		<references/>


			<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">
			<div style="font-weight:bold;">📊 BMI / Body Surface Area Calculator [show]</div>
			<div class="mw-collapsible-content">
			{{BMI_Calculator}}
			</div>
			</div>
	[[Category:Misc/General]]		[[Category:Misc/General]]

ClaireLewis: /* Airway Management */

2019-10-13T14:12:09Z

Airway Management

← Revisión anterior		Revisión del 14:12 13 oct 2019
Línea 81:		Línea 81:

	==Airway Management==		==Airway Management==
	Obesity associated with difficult bag-mask ventilation (~~BMV~~) and intubation		Obesity associated with difficult bag-mask ventilation ([[BVM]]) and intubation
	*Consider prolonged pre-oxygenation period and two provider BMV		*Consider prolonged pre-oxygenation period and two provider BMV
	*May improve lung function through use of pre-intubation period of NIPPV		*May improve lung function through use of pre-intubation period of [[NIPPV]]
	**Obesity hypoventilation syndrome may cause chronic hypercapnia		**Obesity hypoventilation syndrome may cause chronic hypercapnia
	*Place patient in "ramp" position		*Place patient in "ramp" position

ClaireLewis at 15:27, 27 September 2019

2019-09-27T15:27:12Z

← Revisión anterior		Revisión del 15:27 27 sep 2019
Línea 8:		Línea 8:
	*Total body weight '''(TBW)'''= Actual weight		*Total body weight '''(TBW)'''= Actual weight
	**May result in over dosing		**May result in over dosing
	*Ideal body weight '''(IBW)'''= Calc. based on height & weight		*[[ideal body weight estimation\|Ideal body weight]] '''(IBW)'''= Calc. based on height & weight
	**May result in under dosing		**May result in under dosing
	*Lean body weight '''(LBW)'''= Difference between TBW and fat mass<br>		*Lean body weight '''(LBW)'''= Difference between TBW and fat mass<br>
Línea 40:		Línea 40:
	\| '''Dose Adjustment '''		\| '''Dose Adjustment '''
	\|-		\|-
	\| Morphine		\| [[Morphine]]
	\| Dose by IBW		\| Dose by IBW
	\|-		\|-
	\| Fentanyl		\| [[Fentanyl]]
	\| Dose by LBW; Alternative: Initial dose TBW, subsequent dose by IBW (risk over dose when use TBW)		\| Dose by LBW; Alternative: Initial dose TBW, subsequent dose by IBW (risk over dose when use TBW)
	\|-		\|-
	\| Midazolam		\| [[Midazolam]]
	\| Initial dose TBW, subsequent dose by IBW		\| Initial dose TBW, subsequent dose by IBW
	\|-		\|-
	\| Propofol		\| [[Propofol]]
	\| Dose by LBW		\| Dose by LBW
	\|-		\|-
	\| Etomidate		\| [[Etomidate]]
	\| Dose by LBW		\| Dose by LBW
	\|-		\|-
	\| Succinylcholine		\| [[Succinylcholine]]
	\| Dose by TBW @ 1mg/kg		\| Dose by TBW @ 1mg/kg
	\|-		\|-
	\| Rocuronium		\| [[Rocuronium]]
	\| Dose by IBW		\| Dose by IBW
	\|-		\|-
	\| Heparin		\| [[Heparin]]
	\| Same as non-obese patient (80U/kg followed by 18U/kg/h using TBW)		\| Same as non-obese patient (80U/kg followed by 18U/kg/h using TBW)
	\|-		\|-
	\| Vancomycin		\| [[Vancomycin]]
	\| 30mg/kg TBW (then follow serum levels)		\| 30mg/kg TBW (then follow serum levels)
	\|-		\|-
	\| Aminoglycosides		\| [[Aminoglycosides]]
	\| Dose by ABW (C= 0.4; then follow serum levels)		\| Dose by ABW (C= 0.4; then follow serum levels)
	\|-		\|-
	\| Beta-lactams		\| [[Beta-lactams]]
	\| No good data, may consider doubling dose		\| No good data, may consider doubling dose
	\|-		\|-
	\| Carbapenems		\| [[Carbapenems]]
	\| No empiric change recommended		\| No empiric change recommended
	\|-		\|-
	\| Antifungals		\| [[Antifungals]]
	\| No empiric change recommended; use LBW when dosing weight-based agents		\| No empiric change recommended; use LBW when dosing weight-based agents
	\|}		\|}

Mholtz: Mholtz moved page The Obese Patient to The obese patient

2017-06-01T04:56:03Z

Mholtz moved page The Obese Patient to The obese patient

← Revisión anterior	Revisión del 04:56 1 jun 2017
(Sin diferencias)

Mholtz at 04:55, 1 June 2017

2017-06-01T04:55:04Z

← Revisión anterior		Revisión del 04:55 1 jun 2017
Línea 1:		Línea 1:
	==Definitions==		==Definitions==
	*~~Overweight =~~ BMI 25-29		*BMI 25-29 = Overweight
	*~~Obesity =~~ BMI 30-39		*BMI 30-39 = Obese
	*~~Morbid obesity =~~ BMI 40-49		*BMI 40-49 = Morbidly obese
	*~~Super obesity =~~ BMI >50		*BMI >50 = Super obese

	==Dosing Scalars==		==Dosing Scalars==
Línea 15:		Línea 15:

	===Estimating Patient Weight===		===Estimating Patient Weight===
	~~Multiple~~ formulas to estimate weight~~, below~~ are most common:		''There are multiple formulas to estimate weight - these are the most common:''

	*'''Estimated male TBW''' = 93.2 + 3.29[arm circumference (cm)] + 0.43[height (cm)]		*'''Estimated male TBW''' = 93.2 + 3.29[arm circumference (cm)] + 0.43[height (cm)]
Línea 95:		Línea 95:

	==[[Lumbar Puncture]]==		==[[Lumbar Puncture]]==
	Obese patients have increased distance from skin to subarachnoid space		*Obese patients have increased distance from skin to subarachnoid space
	*Upright patient positioning improves LP success		*Upright patient positioning improves LP success
	*Estimated lumbar puncture depth (cm) = 1 + 17[weight(kg)/height(cm)]		*Estimated lumbar puncture depth (cm) = 1 + 17[weight(kg)/height(cm)]
	*Ultrasound may improve ~~the ID~~ of landmarks		*Ultrasound may improve identification of landmarks
	*If failure, consider fluoroscopy guided		*If failure, consider fluoroscopy-guided procedure by IR

	==References==		==References==

JRAmeli: /* Lumbar Puncture */

2017-05-31T15:44:52Z

Lumbar Puncture

← Revisión anterior		Revisión del 15:44 31 may 2017
Línea 99:		Línea 99:
	*Estimated lumbar puncture depth (cm) = 1 + 17[weight(kg)/height(cm)]		*Estimated lumbar puncture depth (cm) = 1 + 17[weight(kg)/height(cm)]
	*Ultrasound may improve the ID of landmarks		*Ultrasound may improve the ID of landmarks
			*If failure, consider fluoroscopy guided

	==References==		==References==

JRAmeli: /* Airway Management */

2017-05-31T15:43:51Z

Airway Management

← Revisión anterior		Revisión del 15:43 31 may 2017
Línea 87:		Línea 87:
	*Place patient in "ramp" position		*Place patient in "ramp" position
	**Stack blankets behind patient's back to horizontally align external auditory meatus with sternal notch		**Stack blankets behind patient's back to horizontally align external auditory meatus with sternal notch
	*Consider Airtraq laryngoscope (shortened mean intubation time & desat episodes vs Mac DL in obese patients) OR hyperangulated video laryngoscope		*Consider Airtraq laryngoscope (shortened mean intubation time & desat episodes vs Mac DL in obese patients) OR other hyperangulated video laryngoscope such as glidescope
	*Increased BMI associated with higher rate of developing ARDS		*Increased BMI associated with higher rate of developing ARDS
	**Methods to improve oxygenation/ventilation:		**Methods to improve oxygenation/ventilation:

JRAmeli: /* Airway Management */

2017-05-31T15:43:11Z

Airway Management

← Revisión anterior		Revisión del 15:43 31 may 2017
Línea 87:		Línea 87:
	*Place patient in "ramp" position		*Place patient in "ramp" position
	**Stack blankets behind patient's back to horizontally align external auditory meatus with sternal notch		**Stack blankets behind patient's back to horizontally align external auditory meatus with sternal notch
	*Consider Airtraq laryngoscope (shortened mean intubation time & desat episodes vs Mac DL in obese patients)		*Consider Airtraq laryngoscope (shortened mean intubation time & desat episodes vs Mac DL in obese patients) OR hyperangulated video laryngoscope
	*Increased BMI associated with higher rate of developing ARDS		*Increased BMI associated with higher rate of developing ARDS
	**Methods to improve oxygenation/ventilation:		**Methods to improve oxygenation/ventilation: