Bicarbonate or Base Excess in Early Obesity Hypoventilation Syndrome

Monneret, Denis

doi:10.1378/chest.15-0189

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…Multiple authors have argued for expanding OHS diagnostic criteria to include calculated serum bicarbonate values of greater than 27 mEq/l from arterial blood gas readings and/or calculated base excess of greater than 2 mmol/l [20 && , [21][22][23]. Not only are bicarbonate and base excess longer term measures of exposure to elevated levels of PaCO 2 , these metrics are also less sensitive to the transient changes in PaCO 2 and PaO 2 often engendered by the anxiety and pain that accompany arterial puncture.…”

Section: Key Pointsmentioning

confidence: 99%

“…Using cutoff values of greater than 27 mEq/l, calculated bicarbonate from arterial blood gases has 90% sensitivity but perhaps only 50% specificity for making a diagnosis of OHS [24], making it a far better tool to rule out OHS rather than diagnose it (up to a 97% negative predictive value) [6]. In addition, Monneret questioned the reproducibility of base excess within individual patients and the variability that can occur when base excess is derived from different instruments, suggesting that calculated arterial standard bicarbonate is a slightly more reliable index [23]. Still, the astute clinician should keep in mind that these values may identify patients at high risk for developing OHS.…”

Section: Key Pointsmentioning

confidence: 99%

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Obesity hypoventilation syndrome

Pierce,

Brown

2015

Current Opinion in Pulmonary Medicine

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OHS is a complex multiorgan system disease process that appears to be driven by adaptive changes in respiratory physiology and compensatory changes in metabolic processes, both of which are ultimately counter-productive. The diurnal hypercapnia and hypoxia induce pathologic effects that further worsen sleep-related breathing, resulting in a slowly progressive worsening of disease. In addition, leptin resistance in obesity and OHS likely contributes to blunting of ventilatory drive and inadequate chemoreceptor response to hypercarbia and hypoxemia.

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Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Obesity hypoventilation syndrome

Pierce,

Brown

2015

Current Opinion in Pulmonary Medicine

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“…Results of both tests are susceptible to preanalytical considerations and, furthermore, are more challenging to obtain than simple venepuncture. Serum bicarbonate, therefore, is potentially the most useful marker of the three, for exclusion of low-suspicion OHS [ 48 ].…”

Section: Serum Bicarbonatementioning

confidence: 99%

Defining obesity hypoventilation syndrome

Shah

Shrimanker

Kaltsakas

2021

Breathe

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With increasing prevalence of obesity, the substantial contribution of obesity hypoventilation syndrome (OHS) to morbidity and mortality is likely to increase. It is therefore crucial that the condition has a clear definition to allow timely identification of patients. OHS was first described as “Pickwickian syndrome” in the 1950s; in subsequent decades, case reports did not clearly delineate between patients suffering from OHS and those suffering from obstructive sleep apnoea. In 1999, the American Academy of Sleep Medicine published a guideline that delineated the cause of daytime hypercapnia as either predominantly upper airway or predominantly hypoventilation. This was the first formal definition of OHS as the presence of daytime alveolar hypoventilation (arterial carbon dioxide tension >45 mmHg) in patients with body mass index >30 kg·m−2 in the absence of other causes of hypoventilation. This definition is reflected in the most recent guidelines published on OHS. Recent developments in defining OHS include proposed classification systems of severity and demonstrating the value of using serum bicarbonate to exclude OHS in patients with a low index of suspicion.Educational aimsTo provide an overview of the historical basis of the definition of obesity hypoventilation syndrome.To explain the rationale for the current definition of obesity hypoventilation syndrome.To demonstrate areas that need further investigation in defining obesity hypoventilation syndrome.

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Obesity Hypoventilation: Pathophysiology, Diagnosis, and Treatment

Sunwoo

2019

Curr Pulmonol Rep

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Bicarbonate or Base Excess in Early Obesity Hypoventilation Syndrome

Cited by 5 publications

References 4 publications

Obesity hypoventilation syndrome

Obesity hypoventilation syndrome

Defining obesity hypoventilation syndrome

Obesity Hypoventilation: Pathophysiology, Diagnosis, and Treatment

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