Sunday, December 27, 2009

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

Return to list of medical syndromes here

(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
(4)Cataletto M, Hertz G; Obesity-Hypoventilation Syndrome and Pulmonary Consequences of Obesity, eMedicine,updated November 2008.


  1. yes it is true daily notes upon progression of COPD man..THANKS

  2. @Sonnet
    not at all you are welcome.


Nice to see your comment here........