An RQ greater than 1.0 indicates excessive CO2 production; what should be done?

• A. Excessive CO2 production; may be due to overfeeding or lipogenesis and increased respiratory demand; decrease total caloric and carbohydrate delivery
• B. Underfeeding; increase caloric intake
• C. Lipogenesis only; ignore
• D. No change in feeding

Answer: (A)

An RQ above 1.0 signals that CO2 production is elevated, often from carbohydrate overfeeding that drives lipogenesis and increases the respiratory load. In this situation the goal is to lessen the metabolic burden by reducing energy delivery, especially carbohydrates, to bring CO2 production back toward what the patient’s ventilation can handle. Practically, this means adjusting the nutrition regimen to lower total calories and cut back on carbohydrates, potentially shifting some energy toward fat while ensuring adequate protein for lean mass. Underfeeding would not address the excess CO2 and could worsen energy deficit, and doing nothing would leave the patient burdened by high CO2.