A review in Intensive Care Medicine summarises what is known about dosing medicines in critically ill patients with severe obesity. The evidence is thin: few such patients are studied, outcomes are rarely clinical, and little of it comes from intensive care.
Obesity changes the apparent volume of distribution and clearance of many drugs, so label doses can under- or overshoot. The authors' central practical message is to choose the correct weight for each weight-based calculation, or the correct fixed dose, and to individualise from there. They provide drug-specific recommendations and a framework, and suggest involving a clinical pharmacist.
This is narrative guidance, not new data. It is a useful reminder that total body weight, ideal body weight and adjusted weight are not interchangeable, and that the right one depends on the drug.
- Record height as well as weight on admission so ideal and adjusted weights can be calculated.
- Check which weight each drug's dose should be based on rather than defaulting to total weight.
- Use drug levels where available for antimicrobials and other narrow-margin drugs.
- Involve a clinical pharmacist for patients with extreme obesity.
Why it matters
Using the wrong weight is one of the commonest and most avoidable dosing errors in intensive care.
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