pickwickian syndrome

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Pickwickian Syndrome



A group of symptoms that generally accompany massive obesity.


Pickwickian syndrome is a complex of symptoms that primarily affect patients with extreme obesity. The syndrome is named after a character in a Charles Dickens novel, The Pickwick Papers, who seemed to show some of the traits of this disease.
The major health problem that occurs in patients with this disease is sleep apnea. This is caused in part by the excess amounts of fatty tissue surrounding the chest muscles. This excess fat places a strain on the heart, lungs, and diaphragm of the patient, making it difficult to breathe.

Causes and symptoms

The major cause of Pickwickian syndrome is extreme obesity. This obesity places an excessive load on the pulmonary system. The role of genetics is also being studied. Symptoms of Pickwickian syndrome include excessive daytime sleepiness, shortness of breath due to elevated blood carbon dioxide pressure, disturbed sleep at night, and flushed face. The skin can also have a bluish tint, and the patient may have high blood pressure, an enlarged liver, and an abnormally high red blood cell count.


Some tests that can be used to diagnose this condition include echocardiography to determine heart enlargement or pulmonary hypertension. Giving the patient multiple sleep latency tests can help give an objective measurement of daytime sleepiness. Magnetic resonance imaging (MRI), computed tomography (CT) scans, or fiberoptic evaluation of the upper airway may also be used.

Key terms

Latency — The period of inactivity between the time a stimulus is provided and the time a response occurs.
Obesity — Exceeding one's normal weight by 20%. A person suffering from extreme obesity would exceed their normal weight by a much higher percentage.
Pulmonary system — Lungs and respiratory system of the body.


The primary treatment for Pickwickian syndrome is focused on weight loss and increased physical activity. Also, medroxyprogesterone may help improve the condition.


Pickwickian sydnrome is entirely reversible if it is diagnosed and treated properly. If the problem goes undiagnosed, the outcome can be fatal.


Prevention of Pickwickian syndrome can be achieved by maintaining a healthy body weight and getting the proper amount of exercise. For prevention of the sleep apnea that generally accompanies Pickwickian syndrome, there are several possible treatments. If the sleep apnea is only present when the patient is flat on their back, a tennis ball can be sewn into the sleep clothes to remind the patient not to sleep on their back. For more severe cases of sleep apnea, a tonsillectomy or the use of dental appliances may be recommended.



Dambro, Mark R. The 5-Minute Clinical Consult. Baltimore: Williams & Wilkins, 2001.
Tierney, Lawrence, et. al. Current Medical Diagnosis and Treatment. Los Altos: Lange Medical Publications, 2001.


"'Apples' and 'Pears': Defining the Shape of the Problem." FP Report 6 (November2000).
Kushner, Robert F., and Roland L. Weinsier. "Evlauation of theObese Patient." Medical Clinics of North America 84 (March2000).

pick·wick·i·an syn·drome

a combination of severe, grotesque obesity, somnolence, and general debility, theoretically resulting from hypoventilation induced by the obesity; hypercapnia, pulmonary hypertension, and cor pulmonale can result.
[after the "fat boy" character in Dickens' early novel The Pickwick Papers]

pickwickian syndrome

Etymology: Pickwick Papers by Charles Dickens
an abnormal condition characterized by obesity, decreased pulmonary function, somnolence, and polycythemia.
A complication of extreme obesity, which is characterised by marked cardiovascular compromise, decreased tidal and expiratory reserve volumes, alveolar hypoventilation, hypoxia, cyanosis and hypercapnia, if severe and prolonged, dyspnoea, polycythemia, cardiac hypertrophy, pulmonary hypertension, pulmonary oedema, congestive heart failure, extreme somnolence, obstructive sleep apnea syndrome; O2 therapy may be fatal, as it removes the chemoreceptor drive needed for respiratory movement

pick·wick·i·an syn·drome

(pik-wik'ē-ăn sin'drōm)
A combination of severe, grotesque obesity, somnolence, and general debility, theoretically resulting from hypoventilation induced by the obesity; hypercapnia, pulmonary hypertension, and cor pulmonale can result.
[after the "fat boy" character in Dickens' early novel The Pickwick Papers]

Pickwickian syndrome

The association of obesity, excessive sleepiness, abnormally shallow breathing and SLEEP APNOEA. The syndrome is related to defective control of respiration and long-term lack of oxygen in the blood. It is named after the fat boy Joe in The Pickwick Papers of Charles Dickens.

pickwickian syndrome

alveolar hypoventilation, somnolence and erythrocytosis associated with extreme obesity as seen in Charles Dickens' fat boy in the Pickwick Papers. A similar syndrome is observed rarely in dogs.
References in periodicals archive ?
1]] for the management of chronic respiratory insufficiency, a condition secondary to diseases such as obesity hypoventilation syndrome, chronic obstructive pulmonary disease (COPD) and neuromuscular disease for adult and pediatric patients (above 10 kg).
Philips Respironics holds leading positions in the fast-growing areas of respiratory care, non-invasive ventilation and sleep management and is currently funding three large European trials investigating the effects of home non-invasive ventilation in patients with COPD and obesity hypoventilation syndrome (OHS).
However, if this increased drive cannot be maintained, hypoventilation will develop (31), and is termed obesity hypoventilation syndrome (OHS).
Improved sleep gas exchange and daytime blood gases can occur in many individuals once upper airway obstruction is relieved, and has been reported in patients with early stage neuromuscular disease (13), scoliosis (27), overlap (96,97) and obesity hypoventilation syndrome (33,86).
Obesity hypoventilation syndrome as a spectrum of respiratory disturbances during sleep.
The mortality rate for gastric bypass surgery averages around 1%, and the rate is higher in massively obese patients, especially those with obesity hypoventilation syndrome.
Although it has been effective in improving oxygenation and correcting hypercapnia in patients with obesity hypoventilation syndrome, it has not proved to be clinically useful in the treatment of normocapnic OSA patients.
The USPTO issued both a composition-of-matter patent and a divisional patent covering methods of use, including the treatment for a broad range of breathing disorders such as opioid-induced respiratory depression, sleep apneas, stroke-induced central sleep apnea, congenital hypoventilation syndrome, obesity hypoventilation syndrome, sudden infant death syndrome, Cheney-Stokes respiration, and additional orphan drug indications.
This calls into question the dire warnings often found in the literature and perhaps we should be concerned less about OSA per se and concentrate our efforts on more complex related problems like obesity hypoventilation syndrome (5).
Sleep-disordered breathing (obstructive and central) and obesity hypoventilation syndrome represent, across several dimensions, a continuum of disorders that also encompasses a further continuum of severity.
Obstructive sleep apnoea' is, commonly and mistakenly, equated by many authors with obesity hypoventilation syndromes and central apnoea syndromes, and indeed the whole complex spectrum of SDB as well as the entire continuum of severity.
It has been acknowledged that even amongst sleep physicians the distinction between severe obstructive sleep apnoea, hypopnoea and obesity hypoventilation syndromes is confused (27).