- Pickwickian syndrome.

Pickwickian syndrome

-Def :- 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.

-Synonyms:- Obesity hypoventilation syndrome(OHS).
-In 1836, Charles Dickens drew in his novel "The posthumous paper of the Pickwick Club" what would be, certainly, the best characterization of an obese subject with respiratory disorders(1).
 

-Clinical picture:-

• concurrent obstructive sleep apnea.
• inverted sleep rhythm.
  
• drowsiness due to elevated co2
• depression
• hypertension (high blood pressure) that is difficult to control with medication (2).
• headaches, which tend to be worse in the morning(3).
• lower limb edema due to heart failure.
• decreased exercise tolerance and exertional chest pain.

- Diagnostic criteria for Pickwickian syndrome(2):-

• Body Mass Index is 30 kg/m2 or more.
• Daytime PaCO2 is 45 mmHg or more (i.e daytime hypercapnia)
  
• Associated sleep-related breathing disorder (sleep apnoea-hypopnoea syndrome or sleep-hypoventilation or both).
• Absence of other known causes of hypoventilation.

-Differential diagnosis(4):-

• Sleep apnoea and other sleep-related breathing disorders
• Prader-Willi syndrome.
• Beckwith-Wiedemann Syndrome.
• Narcolepsy
• Use/abuse of sedatives and antihistamines
• Sleep deprivation.

-Treatment:-

• The most important treatment is weight loss.
• If the symptoms are significant, nighttime positive airway pressure (PAP) treatment is tried.

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*References:-

(1) THE NEW AVENTURES OF MR PICKWICK.
(2)Olson AL, Zwillich C (2005). "The obesity hypoventilation syndrome". Am. J. Med. 118 (9): 948–56. doi:10.1016/j.amjmed.2005.03.042.PMID 16164877
(3) McNicholas, WT; Phillipson EA (2001). Breathing Disorders in Sleep. Saunders Ltd.. pp. 80. ISBN
0702025100..
(4)Cataletto M, Hertz G; Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity, eMedicine,updated November 2008.