Pickwick's syndrome is a pathological condition characterized by progressive respiratory failure, with no primary pulmonary pathology. Simultaneously, with Pickwick's syndrome there is a development of pulmonary heart in combination with drowsiness and obesity. Also Pickwick syndrome due to the observed extreme degree of obesity, leads to the inability to breathe fast enough and deeply, which leads to a marked decrease in blood levels of oxygen and a higher value of carbon dioxide. This syndrome is considered to be a subtype of obstructive sleep apnea, which is most common in the male half of humanity in the age range from forty to sixty years.
Causal reason syndrome
Presumably, the development of the Pickwick syndrome is associated with various injuries and diseases of the Central Nervous System. Also, for possible reasons, it is customary to include pathology of labor, mental illness and mental trauma. However, it is not always possible to establish a clear connection between the development of Pickwick's syndrome and the diseases that have been transferred.
It was noted that not all people with excessive body weight suffer from this syndrome. Proceeding from this, it can be concluded that the development of this syndrome in complete people lead to any individual genetic characteristics. The statement of some doctors that Pickwick's syndrome develops only in people with obesity is erroneous, because this condition is often diagnosed in people whose body weight does not fit the criteria of excess weight.
The pathogenesis of the Pickwick syndrome has not yet been studied enough. It is believed that the leading factor is a violation of the adequate functioning of the central nervous system, namely the hypothalamus, which is manifested by sleep disorders, increased appetite, obesity, a decrease in lung ventilation, due to respiratory disorders. Hypoventilation of the lungs often leads to hypertension of the small circulatory system (MCC) with a violation of the acid-base balance, hypercapnia and the development of the pulmonary heart . Often observed hypoxia with secondary erythrocytosis.
Pickwick syndrome symptoms
Pickwick syndrome is characterized by three main symptoms: breathing disorders, drowsiness and obesity (usually abdominal type, when there is a significant increase in the abdomen). Excess body weight entails an increase in intra-abdominal pressure, a violation of gas exchange processes, a weakening of the movements of the diaphragm. Due to the increased number of red blood cells, the blood becomes dense, which causes the heart to work harder, resulting in a deterioration in the viability of cells, especially the brain.
The large abdomen in a prone position strongly enough squeezes the diaphragm, which presses the lungs, thereby stopping breathing. Accustomed to being in conditions of oxygen starvation, brain cells command to restore breathing only when the incoming oxygen is very low. As a result, the night sleep of a person with Pickwick's syndrome consists of alternating episodes of oxygen deficiency and frequent unremarkable awakenings, which subsequently leads to a permanent drowsiness during the day.
The main symptoms of the Pickwick syndrome are as follows:
- Central acrocyanosis and cyanosis
- The extreme degree of obesity (3-4)
- Prolonged limitation of pulmonary respiration
- Sleep disorders and snoring
- In the daytime, pronounced drowsiness
- Edema. Initially, they appear on the legs and feet, after which the total edema of the subcutaneous tissue may develop over time. If there is a buildup of fluid in the natural cavities of the body - develops pleural edema
- Shortness of breath. It is observed in a state of rest with a labored exhalation and inhalation, is enhanced by falling asleep and physical exertion
- Periodic breathing stops ( apnea ) and intermittent breathing, especially in sleep, and with pronounced Pickwick syndrome also during the day
- Hypoxia and hypercapnia
- Arterial and pulmonary hypertension
- Fast fatiguability
- Abnormal increase in the number of erythrocytes (polycythemia)
When examining a patient with Pickwick's syndrome, obesity is observed, with predominant deposition of fat on the chest, face, abdomen (especially large deposits). These people have cyanosis of the skin and mucous membranes, there are noticeable swelling. Cyanosis and dyspnea are markedly amplified in the position of the body lying on the back and under physical exertion. X-ray is determined by the reduction of respiratory excursion of the diaphragm and elevation of the lower border of the lungs. There may be an increase in blood pressure.
Pickwick's syndrome treatment
Therapy of the Pickwick syndrome should be started only in specialized clinics where a sleep laboratory is available. Treatment of Pickwick's syndrome is a rather complicated procedure, because Inefficiency of standard schemes is noted. An individual approach is required taking into account the developed cardiac pathological phenomena and changes in the composition of the blood.
The leading place in the treatment of this disease is symptomatic therapy, primarily aimed at maximum weight loss. For this purpose, a specially designed diet is prescribed (from 600 to 800 kcal for the first seven to ten days, after which 1200 kcal per day).
Patients with hypercapnia are shown inhalation of oxygen in a mandatory combination with respiratory analeptics, under the control of the dynamics of the presence of carbon dioxide in the plasma. To stimulate diaphragmatic breathing, exercise therapy is prescribed. When decompensating the pulmonary heart, diuretics and cardiac glycosides are indicated for use. In order to improve night sleep, it is recommended to take Cordiolina (inside 1 tsp) for the night and an elevated position of the trunk. Sleeping pills that depress the respiratory center are contraindicated!
The prognosis of Pickwick's syndrome is quite unfavorable because of the high mortality rate due to pathological changes in the lungs and heart, as well as stopping breathing in a dream. Without treatment, lethality reaches 70%.