Comprehensive Clinical Insights into the Diagnosis, Management and Complications of Pickwickian Syndrome | Chapter 8 | Medical Science: Updates and Prospects Vol. 2

 

The aim of this study is to provide a comprehensive and up-to-date synthesis of the clinical understanding of Pickwickian Syndrome, with a focus on its diagnosis, management, and associated complications. Pickwickian Syndrome, or Obesity Hypoventilation Syndrome (OHS), is a serious obesity-related respiratory disorder defined by chronic daytime hypercapnia (PaCO₂ > 45 mmHg), obesity (BMI ≥ 30 kg/m²), and exclusion of other hypoventilation causes. It arises from a complex interplay of impaired ventilatory drive, leptin resistance, and mechanical respiratory restriction, often coexisting with obstructive sleep apnea (OSA) in nearly 90% of cases. OHS leads to chronic hypoxemia, pulmonary hypertension, and cor pulmonale if untreated. Diagnosis relies on arterial blood gas analysis, polysomnography, and exclusion of alternative etiologies. A key diagnostic feature is chronic hypercapnia (PaCO₂ >45 mmHg), often accompanied by compensated metabolic alkalosis due to renal bicarbonate retention.  There may also be hypoxemia (PaO₂ <70 mmHg), particularly in more severe cases. Management requires a multidisciplinary approach emphasising weight reduction, lifestyle modification, and positive airway pressure (PAP) therapy—CPAP for OHS with OSA and BiPAP for persistent hypercapnia. Bariatric surgery offers substantial improvement in severe cases. Pharmacologic agents like acetazolamide and medroxyprogesterone serve limited roles. Early recognition and adherence to therapy markedly improve outcomes, reducing mortality from 30% to under 10%. Despite advancements, OHS remains underdiagnosed and undertreated, highlighting the need for greater clinical awareness, digital monitoring integration, and personalised management strategies.

 

 

Author(s) Details

Harsahaj Singh Wilkhoo
Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.

 

Afra Wasama Islam
Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v2/6708