The Pickwickian Syndrome

Introduction The Pickwickian syndrome is a group of symptoms, including cardiac decompensation, that accompanies the state of massive obesity associated with alveolar hypoventilation. The title of the syndrome was adapted from Dickens' classical description of the fat boy in the Pickwick Papers (Fig. 1): ... and on the box sat a fat and red faced boy in a state of somnolency... leaden eyes... behind his mountainous cheeks... an extraordinary boy... with difficulty... roused from lethargy. This quotation could well have been written into the medical record of the case to be presented, as an appropriate appraisal of the appearance of this 4-year-old boy as he was wheeled down the hall on his admission to the pediatric floor of our hospital. The Pickwickian syndrome includes as its major points: Massive exogenous obesity Somnolence Cyanosis Hypercapnia Right electrical axis deviation on electrocardiogram Right ventricular failure Other documented