An energy ratio of fats and carbohydrates should be considered while adapting to energy needs.
50:50 ratio for ventilated patients compared to 30:70 ratio for subjects without respiratory complications.

Fat and Carbohydrate Recommendations for Ventilated COVID-19 Patients

- For critically ill patients with COVID-19, carbohydrate intake must be strictly regulated because the oxidation of carbohydrates leads to the production of carbon dioxide, and excess carbon dioxide production is harmful for patients with respiratory failure. 
- The patient must not take in more than 150g of carbohydrates per day. 

Santa Clara University

As therapeutic interventions remain largely experimental, supportive care in the form of nutrition management is integral for critically ill patients.

Nutrition Therapy in Critically Ill Patients With CoronavirusDisease 2019

Romano, L., Bilotta, F., Dauri, M., Macheda, S., Pujia, A., De Santis, G. L., Tarsitano, M. G., Merra, G., Di Renzo, L., Esposito, E., & De Lorenzo, A. (2020). Short Report - Medical nutrition therapy for critically ill patients with COVID-19. European review for medical and pharmacological sciences, 24(7), 4035–4039. https://doi.org/10.26355/eurrev_202004_20874

Short Report – Medical nutrition therapy for critically ill patients with COVID-19

- The European Review for Medical and Pharmacological Sciences recommends 20-30kcal/kg/day for patients with COVID-19, as it is critical to avoid underfeeding or overfeeding. 
- Patients with COVID-19 require more energy than they normally would. For every 1 degree celsius increase in body temperature, the body's caloric needs increase by 10%. 
- Protein supply should be increased to reduce the metabolism of inflammatory compounds; carbohydrate intake should be limited to reduce CO2 generation in the lungs

Caloric Intake Recommendations for Critically Ill Patients With COVID-19

- The European Review for Medical and Pharmacological Sciences recommends to make protein the top priority, taking in 1.3g/kg of bodyweight/day of protein in order to lower the amount of catabolism occurring from the inflammatory cytokines involved in COVID-19. (Note: this does not apply to patients in the anabolic phase). 


Protein Recommendations for Critically Ill Patients With COVID-19

Carbohydrate Recommendations for Critically Ill Patients With COVID-19

Magnesium is critical for the general maintenance of overall human health.   However, recent studies and research, including multiple clinical trials, reviews, and meta-analyses, have pointed to evidence indicative of magnesium supplementation resulting in positive effects in individuals with lung diseases, such as pneumonia and asthma.  This is because magnesium possesses anti-inflammatory effects, anti-oxidative effects, and relaxes bronchial smooth muscle.  Further, magnesium supplementation could potentially mitigate some of the adverse side effects that may result from current antiviral drugs used to treat COVID-19 patients due to the various beneficial properties magnesium possesses within the human body.  For example, magnesium supplementation can mitigate dyslipidemia and hepatotoxicity that can be caused from treatment with lopinavir-ritonavir.  Magnesium supplementation can also mitigate neuromyotoxicity or cardiac toxicity that results from chloroquine treatment.  




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