doiSerbia

Pickwickian syndrome - "the tip of the iceberg" in extremely obese patients

Kašćak Jelena (Municipal Institution for Emergency Medical Care, Belgrade, Serbia)
Anđelić Slađana (Municipal Institution for Emergency Medical Care, Belgrade, Serbia)

Introduction. Pickwickian syndrome (PS), also known as hypoventilation syndrome in adults, consists of three factors: obesity [Body Mass Index (BMI) > 30 kg/m2], daytime hypercapnia and sleep-disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. Timely recognition of PS is of utmost importance because such patients have significant morbidity and mortality. However, recent data indicate that PS is under-recognized and under-treated. We report a case of early-identified PS prehospitally with a favorable outcome after hospital treatment. Case outline. A 67-year-old female patient was diagnosed prehospitally, and the diagnosis was later confirmed in hospital. Diagnostic criteria were as follows: BMI > 45,7 kg/m2 (height 170 cm, weight 132 kg), hypercapnia, hypoxemia and respiratory acidosis (pCO2 – 41 mmHg, pO2 – 56 mmHg, pH 7.45) in the absence of other causes of hypoventilation. During hospitalization, the following diagnostic procedures were performed: standard laboratory analyses, chest radiography, electrocardiography, abdomen and heart echocardiography. An attempted sleep study (polysomnography) was interrupted due to a drop in oxygen saturation levels. Non-invasive mechanical ventilation and a diet were used as the first line of therapy. However, due to the development of a global respiratory insufficiency, the patient was intubated and placed on a mechanical ventilator. After 30 days of hospital treatment, the patient was released in a satisfactory general condition with recommendations for weight reduction and symptomatic therapy. Conclusion. As obesity is becoming an epidemic of modern society, early recognition and treatment of PS is of crucial importance.

Keywords: obesity, Pickwick syndrome, early recognition, treatment