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The Pickwickian Syndrome: Studies on Ventilation and Carbohydrate Metabolism: Case Report of a Child Who Recovered

The Pickwickian Syndrome: Studies on Ventilation and Carbohydrate Metabolism: Case Report of a... Abstract Introduction The rarity of extreme obesity in childhood, and the even greater rarity of hypoventilation secondary to obesity is suggested by the paucity of children with the Pickwickian syndrome previously reported1-3,17 (Table 1). The cardiorespiratory syndrome of obesity with polycythemia, arterial unsaturation, somnolence, hypercapnia, and pulmonary hypertension, found in approximately 10% of extremely obese adults, may be fatal if unrecognized, and may be reversible with weight loss.The purpose of this report is to present the course of the first child proved to have alveolar hypoventilation in association with obesity; to consider the causal factors of her hypoventilation; to discuss her carbohydrate metabolism, and to present ventilatory studies on other obese children. Case History A 4½-year-old female was admitted to The Johns Hopkins Hospital for evaluation of extreme obesity, which had been present since the age of 6 months. From the family history it was learned that several cases References 1. Jenab, M.; Lade, R. I.; Chiga, M.; and Diehl, A. M.: Cardiorespiratory Syndrome of Obesity in a Child: Case Report and Necropsy Findings , Pediatrics 24:23, 1959. 2. Spier, N., and Karelitz, S.: The Pickwickian Syndrome: Case in a Child , Amer J Dis Child 99:822, 1960.Crossref 3. Cayler, G.; Mays, T.; and Riley, H. D.: Cardiorespiratory Syndrome of Obesity (Pickwickian Syndrome) in Children , Pediatrics 27:237, 1961. 4. Naimark, A., and Cherniack, R. M.: Compliance of the Respiratory System and Its Components in Health and Obesity , J Appl Physiol 15: 377, 1960. 5. Said, S.: Abnormalities of Pulmonary Gas Exchange in Obesity , Ann Intern Med 53:1121, 1960.Crossref 6. Hackney, J. D.; Crane, M. G.; Collier, C. C.; Rokaw, S.; and Griggs, D.: Syndrome of Extreme Obesity and Hypoventilation: Studies of Etiology , Ann Intern Med 51:541, 1959.Crossref 7. Alexander, T. K.; Amad, K. H.; and Cole, V. W.: Observations on Some Clinical Features of Extreme Obesity With Particular Reference to Cardiorespiratory Effects , Amer J Med 32:512, 1962.Crossref 8. Fishman, A. P.; Turing, O. M.; Bergofsky, E. H.: The Syndrome of Alveolar Hypoventilation , Editorial, Amer J Med 23:333, 1957.Crossref 9. Vogel, J.; Weaver, W. F.; Rose, R. L.; Blount, G. S.; and Grover, R. F.: Pulmonary Hypertension on Exertion in Normal Man Living at 10,150 Feet (Leadville, Colo), presented at the 5th Annual Conference on Research in Emphysema, "Normal and Abnormal Pulmonary Circulation," Aspen, Colo, June 13-16, 1962. 10. Ogilvie, F.: Sugar Tolerance in Obese Subjects , Quart J Med 4:345, 1935. 11. Rabinowitz, D., and Zierler, K. L.: Forearm Metabolism in Obesity and Its Response for Intra-Arterial Insulin , Lancet 2:690, 1961.Crossref 12. Morse, W. I.; Sedonov, J. J.; Soeldner, J. S.; and Dickson, R. C.: Observations on Carbohydrate Metabolism in Obesity , Metabolism 9:666, 1960. 13. Stunkard, A. J.; Van Itallie, T. B.; and Reiss, B. B.: The Mechanism of Satiety: Effect of Glucagon on Gastric Hunger Contractions in Man , Proc Soc Exp Biol 89:258, 1955.Crossref 14. Stunkard, A. J., and Wolff, H. G.: Studies on the Physiol of Hunger: The Effect of Intravenous Administration of Glucose on Gastric Hunger Contractions in Man , J Clin Invest 35:954, 1956.Crossref 15. Mayer, J.: Genetic Traumatic and Environmental Factors in the Etiology of Obesity , Physiol Rev 33:472, 1953. 16. Bernstein, L. M., and Grossman, M. I.: An Experimental Test of the Glucostatic Theory of the Regulation of Food Intake , J Clin Invest 35:627, 1956.Crossref 17. Ward, W. A., and Kelsey, W. M.: The Pickwickian Syndrome , J Pediat 61:745, 1962.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

The Pickwickian Syndrome: Studies on Ventilation and Carbohydrate Metabolism: Case Report of a Child Who Recovered

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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1963 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1963.02080050253002
Publisher site
See Article on Publisher Site

Abstract

Abstract Introduction The rarity of extreme obesity in childhood, and the even greater rarity of hypoventilation secondary to obesity is suggested by the paucity of children with the Pickwickian syndrome previously reported1-3,17 (Table 1). The cardiorespiratory syndrome of obesity with polycythemia, arterial unsaturation, somnolence, hypercapnia, and pulmonary hypertension, found in approximately 10% of extremely obese adults, may be fatal if unrecognized, and may be reversible with weight loss.The purpose of this report is to present the course of the first child proved to have alveolar hypoventilation in association with obesity; to consider the causal factors of her hypoventilation; to discuss her carbohydrate metabolism, and to present ventilatory studies on other obese children. Case History A 4½-year-old female was admitted to The Johns Hopkins Hospital for evaluation of extreme obesity, which had been present since the age of 6 months. From the family history it was learned that several cases References 1. Jenab, M.; Lade, R. I.; Chiga, M.; and Diehl, A. M.: Cardiorespiratory Syndrome of Obesity in a Child: Case Report and Necropsy Findings , Pediatrics 24:23, 1959. 2. Spier, N., and Karelitz, S.: The Pickwickian Syndrome: Case in a Child , Amer J Dis Child 99:822, 1960.Crossref 3. Cayler, G.; Mays, T.; and Riley, H. D.: Cardiorespiratory Syndrome of Obesity (Pickwickian Syndrome) in Children , Pediatrics 27:237, 1961. 4. Naimark, A., and Cherniack, R. M.: Compliance of the Respiratory System and Its Components in Health and Obesity , J Appl Physiol 15: 377, 1960. 5. Said, S.: Abnormalities of Pulmonary Gas Exchange in Obesity , Ann Intern Med 53:1121, 1960.Crossref 6. Hackney, J. D.; Crane, M. G.; Collier, C. C.; Rokaw, S.; and Griggs, D.: Syndrome of Extreme Obesity and Hypoventilation: Studies of Etiology , Ann Intern Med 51:541, 1959.Crossref 7. Alexander, T. K.; Amad, K. H.; and Cole, V. W.: Observations on Some Clinical Features of Extreme Obesity With Particular Reference to Cardiorespiratory Effects , Amer J Med 32:512, 1962.Crossref 8. Fishman, A. P.; Turing, O. M.; Bergofsky, E. H.: The Syndrome of Alveolar Hypoventilation , Editorial, Amer J Med 23:333, 1957.Crossref 9. Vogel, J.; Weaver, W. F.; Rose, R. L.; Blount, G. S.; and Grover, R. F.: Pulmonary Hypertension on Exertion in Normal Man Living at 10,150 Feet (Leadville, Colo), presented at the 5th Annual Conference on Research in Emphysema, "Normal and Abnormal Pulmonary Circulation," Aspen, Colo, June 13-16, 1962. 10. Ogilvie, F.: Sugar Tolerance in Obese Subjects , Quart J Med 4:345, 1935. 11. Rabinowitz, D., and Zierler, K. L.: Forearm Metabolism in Obesity and Its Response for Intra-Arterial Insulin , Lancet 2:690, 1961.Crossref 12. Morse, W. I.; Sedonov, J. J.; Soeldner, J. S.; and Dickson, R. C.: Observations on Carbohydrate Metabolism in Obesity , Metabolism 9:666, 1960. 13. Stunkard, A. J.; Van Itallie, T. B.; and Reiss, B. B.: The Mechanism of Satiety: Effect of Glucagon on Gastric Hunger Contractions in Man , Proc Soc Exp Biol 89:258, 1955.Crossref 14. Stunkard, A. J., and Wolff, H. G.: Studies on the Physiol of Hunger: The Effect of Intravenous Administration of Glucose on Gastric Hunger Contractions in Man , J Clin Invest 35:954, 1956.Crossref 15. Mayer, J.: Genetic Traumatic and Environmental Factors in the Etiology of Obesity , Physiol Rev 33:472, 1953. 16. Bernstein, L. M., and Grossman, M. I.: An Experimental Test of the Glucostatic Theory of the Regulation of Food Intake , J Clin Invest 35:627, 1956.Crossref 17. Ward, W. A., and Kelsey, W. M.: The Pickwickian Syndrome , J Pediat 61:745, 1962.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Sep 1, 1963

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