MedGem Indirect Calorimeter Training Slides

MedGem Training Module
This course is designed to teach you how to use the
MedGem device to personalize your clients’ nutrition
and exercise programs. At the completion of this
training, you will be able to:
• Define and understand resting metabolic rate (RMR).
• Be able to perform a measurement using the MedGem device.
• Interpret and apply the measurement.
• Answer frequently asked questions.
© 2014 All Rights Reserved. No duplication and distribution without permission!

Resting Metabolic Rate
The Missing Link to Weight Management
Your resting metabolic rate is the number of calories
your body burns each day with no activity. It makes
up the majority (60-75% in healthy individuals and
100% in critically ill) of calories burned each day.
Resting metabolic rate is unique to each individual
and is affected by a number of factors:
• Age
• Body Weight
• Medications
• Fever and/or Infection
• Weight Loss
1 Danforth, E. LifeSci 28:1891-1897, 1981.
2 Fung EB, AACN Clinical Issues 11(4): 480-497, 2000.
• Gender
• Genetics
• Hormones
• Exercise
• Nutritional Supplements

Predictive Equations are inaccurate
for Healthy and III Individuals
Healthy Individuals
RMR can vary significantly from person to person – up to
900 calories per day in healthy people.
Ill Individuals
Several studies have indicated predictive equations are
significantly different than measured RMR. Equations can
overestimate RMR by as much as 59% and underestimate
as much as 30% in sick individuals.
This variability can result in very different outcomes for individuals.
ADA’s Adult & Pediatric Weight Management Guidelines:
“If possible, Indirect Calorimetry, should be used for assessing RMR when
developing energy plans.”
1. Foster, G, et al. Metabolism, 1988; 37(5), 467-472
2. Mann et al, Crit Care Med 1985: 13: 173-177
3. Weissman et al, Journal of Anesthesiology 1986: 64: 673 679
4. ABA-EBL: www.ADAevidencelibrary.com

RMR Varies Among Healthy and Ill Individuals
Foster, G, et al. Metabolism, 37(5): 467-472, 1988
Hunter D, et al. Br J Surg, 75: 875-878,1988,
Welis, P. Am J Clin, 88; 959-970, 2008,

Clinical Benefits of Measuring RMR
Measuring RMR enables you to gauge the effects of the
client’s condition on his/her calorie needs and adjust
your nutrition recommendations accordingly. Conditions
that impact your RMR include:
• disease severity and point of time in disease process
• change in medications/dosage
• change in dietary regimen
• change in weight (+/- 5%)
Benefits
Providing appropriate feeding minimizes the percentage of clients who
are overfed and underfed.
Patients following a diet plan established from measured RMR lose more
weight compared to diet plans that estimate RMR.
Measuring RMR to establish appropriate nutritional needs can result in
direct cost savings by avoiding unnecessary nutritional support.
1. Alberda et al., Nutri Clin Pract 17: 38-42, 2002
2. McDoniel, et al., Obes Facts (1)6; 298-304, 2008.
3. McClave et al, JPEN 22; 375-381, 1998.

Candidates for Metabolic Measurement
Some facilities use the device on every individual as
part of their initial nutrition assessment to determine
baseline calorie needs; others choose to use the device
on individuals that meet certain criteria that put them at
high risk for complications associated with overweight
and obesity.
Sample criteria for determining medical necessity for diagnostic
procedure (CPT 94690). Average payer reimbursement is $50-$80.
• 414 Chronic Pulmonary HT Disease
• 428 Heart Failure*
• 493 Asthma*
• 496 COPD*
• 51.8 Lung Involvement in other disease*
• 780.5 Obstructive Sleep Apnea
• 786.5 Dyspnea*
• 786.9 Hypoventilation Syndrome*
• 244.9 Hypothyroidism
• 250 Diabetes Mellitus
• 272.1 Hypercholesterolemia
• 22.4 Hyperlipidemia
• 277.7 Metabolic Syndrome
• 278 Obesity
• 401 Hypertension
• 414 Cardiovascular Disease
*CMS indicates medical necessity

Performing a Measurement
About the MedGem Device
The MedGem is a hand-held indirect calorimeter that
measures oxygen consumption to determine resting
metabolic rate.
The MedGem device is easy to use, providing
measurements quickly and accurately. Useful as a tool
for monitoring changes in metabolism, the MedGem
gives you important information to help your clients
achieve their personal weight management, nutrition,
and exercise goals.
“The validation results suggest the MedGem can be used to accurately measure oxygen
consumption and RMR in long-term healthcare facilities, low-capacity hospitals, athletic training
centers, health clubs, and weight loss clinics.”
Richard Branson, MS, RTT
University of Cincinnati Medical Center, Cincinnati, OH
1. RMR is calculated using the Weir equation and a constant RQ value of 0.85 (RMR=6.931 X VO2),
Weir,JB., New Methods for Calculating Metabolic Rate with Special Reference to Protein Metabolism. J Physiology, 1949, 109; 1-9.

Getting Acquainted with MedGem
• The start button and LED indicator light are
located on top.
• The air vent is located on the bottom of the
device.
• The device is powered by a DC power
supply, which plugs into the side of the
MedGem.

MedGem Measurement Protocol
Acceptable Conditions:
1. Measurement is performed in quiet environment.
2. Individual rests for 10-15 minutes prior to measurement.
3. Individual has not exercised for at least 4 hours.
4. Individual has not consumed caffeine for at least 4 hours.
5. Individual has not consumed nutrition supplements for at least 4 hours.
6. Individual has not used nicotine for at least 1 hour.
7. Individual is not taking acute medications. Chronic medications are OK.
8. Individual may have water prior to measurement.

1. Plug cord in wall outlet.
2. Plug cord in device.
3. Device will beep. LED light turns from red to green to orange.

4. Place MedGem on a table away from fans or vents.
5. Insert mouthpiece into the MedGem.
6. Push orange button to begin self-calibration process.

7. Self-calibration completed when
device beeps and LED light turns to
green.
8. Hand device to the client and ensure there is
a tight seal around the mouthpiece.
9. Client should be seated or in a supine
position and breathing normally into device.
10. The MedGem will beep when the
measurement is completed.
11. Record RMR and discard mouthpiece and
noseclip.

Tracking the Measurements
Codes beginning with “C-” (ie C-10) refer to the
remaining number of measurements that may be performed
with a particular MedGem device.
(C-10 means you have 10 remaining
measurements).
A two-tone audible alert, combined with a flashing
amber and green light indicates the MedGem is low on
measurements. To acknowledge this warning and begin
self-calibrating the device, press the Start button twice.
When you receive a low measurement warning,
contact Microlife Medical Home Solutions to arrange for
delivery of a replacement.

Error Codes
Errors beginning with “0” (ie 01, 05) indicate user errors.
Refer to the user manual for instructions.
Solutions:
1. Ensure the flowtube is firmly placed into the device.
2. Ensure the single-use mouthpiece is firmly inserted into the flowtube.
3. Ensure the client has a proper seal around the mouthpiece and noseclip
is properly positioned on their nose. The client should only be able to
breathe through their mouth.
4. Repeat the measurement.
Errors beginning with any other number (ie 11) may indicate possible
internal error. Contact Microlife Medical Home Solutions for instructions.

Caring for the MedGem Device
Here are some guidelines for properly caring for the
device.
Do not expose the inside of the MedGem to cleaning solutions
or water. If necessary, the outside of the MedGem can be
cleaned with any of the following:
• Soft, clean cloth
• Clorox disinfecting wipes
• Soap and water
Store you MedGem in its case when not in use.

The Missing Link
Through self-monitoring, health professionals have
been able to help clients track how many calories they
eat. But that’s only half of the energy balance equation.
Your clients need to know how many calories they burn.
Purposeful exercise and lifestyle/occupation
activities contribute to the number of calories burned by
an individual.
Resting metabolic rate, however, accounts for the
majority of calories burned and has been the missing link
in nutrition programs.

“Is my RMR good or bad?”
Unlike other health assessments (ie: blood pressure,
etc), RMR assessments are not good or bad. RMR is unique to
your clients physiology. Therefore, RMR may be higher or
lower than other like individuals.
The MedGem Analyzer will provide you metabolic range
for each client. The metabolic range is based on the level of
oxygen consumption and current body weight of your client.

“What do I do with the RMR number?”
Now you have information you need to develop a
balanced, personalized nutrition and exercise plan for your
clients.
Microlife Medical Home Solutions, Inc. offers several
options for developing a calorie budget for individuals. Please
visit our website at www.mimhs.com to learn how the
MedGem Analyzer can help you develop a nutritional plan for
your clients.

“What do I do with the measurement result?”
Weight Loss Case Study
Brian has a BMI of 32.3 kg/m. He was recently diagnosed with
non-insulin dependent diabetes and hypertension. His physician
recommends Brian lose 25 pounds by his next appointment in ~3
months. The MedGem Analzyer will generate an individual
treatment plan for his weight loss goal.
• Current weight: 245 lbs
• Goal weight: 220 lbs
• RMR: 2300 kcals VO2: 332 ml/min
• Occupation: Computer Programmer (~45 hours/wk)
• Goal date: 12 weeks
• Exercise plan: Elliptical Trainer and/or walking moderate-intensity for 30
minutes, 5 days per week

“What do I do with the measurement result?”
Weight Loss Case Study
Personalized Program: For Brian to lose 25 lbs, he will need to consume
1685 calories per day.
• Daily Energy Expenditure: 2685 kcals (determined by Analyzer)
• Rate of Weight Loss: -1000 kcal (2 lbs per week)
• Daily Calorie Needs for weight loss: 1685 kcals
With Brian’s exercise plan, he will burn an additional 245 kcals. Therefore, Brian
could consume 1930 kcals on the days he exercises and still reach his weight goal
by his goal date.
• Daily Calorie Needs for weight loss 1685 kcals
• Exercise Program: +245 kcals
• Daily Calorie Needs with exercise 1930 kcals

Why Re-Measure?
Resting metabolic rate can change significantly during a weight
management program. Re-measuring RMR will ensure that
your clients are on a successful track for long-term weight
management success or appropriate recovery.
You should re-measure individuals:
• +/- 5% - 10% weight change during a weight management
program
• If no weight loss has occurred in the first few weeks
• If individual has reached a weight loss plateau
• When there is a change in medications or a medical condition
• When there is no response to nutritional therapy

Avoiding Common Pitfalls
Problem: Lost Readings
Tim, a weight loss client, arrives for his RMR appointment. You
seat him in a quiet room and allow him to relax as you review
the measurement procedures and set up the MedGem device.
You begin the measurement after calibrating the device. About
5 minutes later, the MedGem beeps indicating the
measurement is complete.
You remove the noseclip and discard the single use
mouthpiece. As you reach for the MedGem, you accidentally
disconnect the power cord and the device shuts off before you
have a chance to record the measurement reading.

Solution: Lost Readings
To recover Tim’s RMR reading, simply plug the power cord back into
the MedGem. After the device powers up, the last RMR measurement will be
displayed. Record the reading.

Problem: Inaccurate Measurements
Mona is anxious to lose the weight she gained from her first pregnancy. She
decides to have her RMR measured. This allows you to develop a personalized
program to help her reach her weight-loss goal.
When she arrives, you seat her in a quiet room and allow her to relax as your
review the measurement procedures and set up the MedGem device. Then, you
perform a measurement.
You make note of the reading, which is 2980, and discard the single-use
mouthpiece and noseclip. The reading is suspiciously high.
What could have gone wrong?

Solution: Inaccurate Measurements
Enter the client’s RMR measurement into the MedGem Analyzer. Compare the
client’s RMR to the listed normal range. Refer to the listed normal range in the
MedGem Analyzer.
When using the MedGem to measure a client’s RMR, it is important to have
the client adhere to proper resting conditions.
If the client has performed physical activity, taken acute medications, has
eaten, or has not rested for 10-15 minutes prior to the measurement, the MedGem
measurement will not be accurate to their actual RMR. Always determine that the
resting conditions were followed before performing a measurement. Developing a
weight loss plan based on this inaccurate reading will prevent the client from reaching
their goals.

Problem: Undetected Air Leak
Brian enrolled in your weight management program. He is 25 pounds
overweight and needs to lower his cholesterol levels and blood pressure.
You seat him in a quiet room and perform the MedGem measurement under
acceptable conditions. You make a note of the reading, which is 1400, then you
discard this single-use mouthpiece and noseclip.
Both you and Brian are suspicious that this RMR reading may be too low since
he weighs 315 pounds.
What could have gone wrong?

Solution: Undetected Air Leak
Brian’s reading may be inaccurate due to an air leak that did not cause an
error message to display. If an air leak occurs, some of the air is not measured by the
device and Brian’s actual RMR would therefore not be determined.
When using the MedGem to measure a client’s RMR, it is important to insure
that all resting conditions are followed. Your client should rest for 10-15 minutes prior
to starting the measurement. Measure your client if he/she has:
• Not eaten or had anything to drink (water is OK) 4 hours prior
• Not exercised 4 hour prior
• Not consumed caffeine or stimulatory nutritional supplements 4 hours prior
• Not used nicotine for 1 hour prior
• Not taken acute medications (ie: antibiotics, pain medication)

Your Clients Will Have Questions!
Your clients will have questions about metabolism, the
MedGem device, and RMR.
Microlife Medical Home Solutions has anticipated many of the
questions that will be asked by you and your clients. The answers are
provided in the MedGem User Guide.
Read the document: MedGem User Guide for answers to
common questions. If you need further assistance, visit our website at
www.mimhs.com.

Congratulations! You’ve reached the end!
Don’t Forget about our additional tools
Measure
Use the MedGem
and MedGem
Analyzer software
to determine RMR
and assess energy
balance for a
personalized
nutrition program.
Monitor
Have clients self-monitor
their food
intake and exercise
using MiHealthLog
health management
application.
Modify
Help you patients
and clients adjust
their nutrition and
exercise plan by
monitoring their
daily health,
nutrition, and
activity goals with
MiHealthCoach.

MedGem Indirect Calorimeter Training Slides

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