Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Nov 11:20:38-41.
doi: 10.1016/j.rmcr.2016.11.005. eCollection 2017.

A case report of malignant obesity hypoventilation syndrome: A weighty problem in our ICUs

Michael Tatusov  1 , Joshua J Joseph  2 , Brian M Cuneo  3
Affiliations
Case Reports

A case report of malignant obesity hypoventilation syndrome: A weighty problem in our ICUs

Michael Tatusov et al. Respir Med Case Rep. .

Abstract

Introduction: The obesity epidemic is reflected by increasing numbers of morbidly obese patients being admitted to intensive care units (ICUs). These are complicated patients whose care involves many diagnostic and treatment challenges. We are presenting a fatal case of super obesity, hypoventilation, and multi-organ failure known as malignant obesity hypoventilation syndrome (MOHS).

Case presentation: 35 year old African American gentleman with a body mass index (BMI) of 115 kg/m2 presented to the hospital with respiratory distress. On admission he was noted to have multi-organ dysfunction including respiratory failure, renal failure, cardiac and liver abnormalities. His hospital course was remarkable for recurrent cardiac arrest following extubation, complicated tracheostomy, and progressive organ failure despite medical therapy. After a 30 day hospitalization, patient and family decided on terminal extubation owing to worsening medical condition and lack of therapeutic and disposition options.

Discussion: The super obese present a number of challenges when admitted to the ICU. Patients with respiratory distress are frequently misdiagnosed and treated for asthma and COPD when obesity hypoventilation syndrome (OHS) is more consistent with the clinical picture. OHS in the superobese is often accompanied by multi-system organ dysfunction, a condition with high morbidity and mortality, with limited treatment options. Standard imaging techniques and procedures are made difficult or impossible by body habitus and often require expert intervention. Surgical options have been used in the treatment of the super obese and resulted in rapid weight loss, improvement in respiratory function, as well as improved metabolism and decreased inflammation. The role of surgery in MOHS remains to be elucidated.

Conclusion: Physicians should be aware of MOHS as a common condition with high morbidity and mortality. Optimal management remains to be determined.

Keywords: Malignant obesity hypoventilation syndrome; Metabolic syndrome; Morbid obesity; Multiple organ failure; Obesity hypoventilation syndrome; Super obesity.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Admission chest X-ray.
Fig. 2
Fig. 2
Excess adipose tissue in the region of the neck and thorax complicating tracheostomy.
See this image and copyright information in PMC

References

    1. Ng M., Fleming T., Robinson M., Thomson B., Graetz N., Margono C. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–781. - PMC - PubMed
    1. Sturm R., Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int. J. Obes. 2013 Jun;37(6):889–891. - PMC - PubMed
    1. Kramer H., Cao G., Dugas L., Luke A., Cooper R., Durazo-Arvizu R. Increasing BMI and waist circumference and prevalence of obesity among adults with Type 2 diabetes: the national health and nutrition examination surveys. J. Diabetes Complicat. 2010 Nov;24(6):368–374. - PubMed
    1. Hubert H.B. The importance of obesity in the development of coronary risk factors and disease: the epidemiologic evidence. Annu. Rev. Public Health. 1986;7:493–502. - PubMed
    1. Landi F., Onder G., Gambassi G., Pedone C., Carbonin P., Bernabei R. Body mass index and mortality among hospitalized patients. Arch. Intern Med. 2000 Sep 25;160(17):2641–2644. - PubMed

Publication types

LinkOut - more resources