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Pickwickian Syndrome
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Obesity Hypoventilation Syndrome
Pickwickian Syndrome
Definition:
Reductions in total lung capacity, vital capacity, functional residual capacity, and increases in residual volume have been shown.
Because of decreased respiratory system compliance and increased resistance, these patients must maintain an increased work and oxygen cost of breathing. This may result in respiratory muscle fatigue.
it is a condition in which severely overweight people fail to breathe rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide (CO2) levels.
Pathophysiology:
- Respiratory system mechanics
- Ventilatory control
- Obstructive sleep apnea-hypopnea syndrome
- Leptin resistance
Difference
between
simple obesity, OSAHS,and OHS
Investigators have identified abnormalities in both hypercapnic and hypoxemic ventilatory responses, which are measurements of ventilatory control.
&
- Fatigue
- Hypersomnolence
- Mood disorders
- Nocturnal or morning headaches
- Loud snoring
- Choking
- Gagging
Patients with simple obesity have an augmented ventilatory response, whereas patients with OHS have a response similar to that of non-obese patients.
Symptoms:
Signs of cor pulmonale which occurs in around one third of OHS patients;
- Raised jugular venous pressure
- Palpable parasternal heave
- Heart murmur
- Leg oedema
- Ascites
- Hepatomegaly
Signs:
Obesity Hypoventilation Syndrome
Thank You
History:
Diagnosis
- Body mass index over 30 kg/m2
- Arterial carbon dioxide level over 45 mmHg
- No alternative explanation for hypoventilation
It was first described in a 1956 case report by
Burwell. This patient resembled a character
depicted by Dickens in his story,
The Posthumous Papers of the Pickwick Club
Take-home Message
Treatment
Evidence suggests that obesity hypoventilation syndrome is under-recognized, undertreated, and associated with a significant increase in mortality.
These findings are particularly disturbing because
effective treatment options exist.
Questions ?
Weight Loss
The ideal treatment for obesity
hypoventilation syndrome
is weight loss.
Progesterone
It increases hypercapnic chemosensitivity
and improve ventilation in patients with
picwickian syndrome.