Abstract Ref Number = APCP1158
POOR PROGNOSTIC IN PATIENT WITH OBESITY HYPOVENTILATION SYNDROME
Fahrul Riza,Bakhtiar Bakhtiar
Syiah Kuala University
Background : Children with severe obesity have many predisposing factor for respiratory disorders. Obesity hypoventilation syndrome (OHS) describes the association between obesity and the development of chronic daytime alveolar hypoventilation. This syndrome arises from a complex interaction between sleep disordered breathing, diminished respiratory drive, and obesity related respiratory impairment, and is associated with significant morbidity and mortality. Delayed diagnostic and treatment will lead to poor prognostic.
Case Presentation Summary : A boy 8-years-old was admitted to Dr. Zainoel Abidin Hospital with dyspnea, snoring, choking during sleep, and excessive daytime sleepiness. In Physical examination, the patient's body weight 54 kg, and the Height 120 cm (BMI 38,19%). The Abdomen Circums is 100 cm. the patient was identified with increased blood pressure, tonsils hypertrophy, stridor, hepatosplenomegaly, severe obesity. the laboratory findings were LDL :465 U/L, NT Pro BNP 1.265 pg/ml, arterial blood gas analyzed with PCO2 68,40 mmHg, PO2 38 mmHg, SaO2 72,4%. The radiology findings were hypertrophic adenoid (ANR: +/- 0,7333) Cardiomegaly and Pneumonia. USG Abdomen: hepatosplenomegaly with fatty liver. Echocardiography: Pulmonal hypertension and diastolic dysfunction. Spirometry conclusion was restrictive (IVC 37%, FEV142%, FEV1/IVC 37%, PEF 40%). Patient was diagnosed with OHS, tonsillitis hypertrophy, pulmonal hypertension, and diastolic dysfunction. Treatment of hypercapnia and upper airway obstruction with CPAP and adenotonsilectomy was failed due to various underlying issues, such as low educated parents and refusal of surgery treatment and poor dietary regulation.
Learning Points/Discussion : This case demonstrated that poor prognostic depend on the communication, information, and education as one of the important sector in managing this patients.
Keywords: obesity hypoventilation syndrome prognostic respiratory disorder