Obesity hypoventilation syndrome Pickwickian syndrome

• Facts:
  Severe obesity ( greater than 150 % of ideal body weight)
  
  
• History / PE:
  Extreme obesity
  Thick neck
  Hypersomnolence
  Distant heart sounds
  Low voltage QRS complexes
• Diagnosis:
  Alveolar hypoventilation during wakefullness
  Chronic hypercapnic, hypoxic respiratory failure
  Respiratory acidosis
  Secondary erythrocytosis
• Treatment:
  Weight loss
  Ventilator support
  Oxygen therapy
  Progestins (respiratory stimulant)
• Complications:
  Pulmonary hypertension with cor pulmonale
• Notes:
  In compensatory effort to maintain normal pH, the kidneys increase bicarbonate retention and decrease chloride reabsorption