[Characteristics of obese patients in intensive care]

The frequency of overweight, together with the associated increase in morbidity--in particular coronary heart disease--means that such patients often require intensive care.

The particular features of intensive care of obese patients are the increased risk of aspiration pneumonia (in the presence of lowered pH and elevated gastric juice volume), respiratory insufficiency caused by a reduction in expiratory reserve volume, and a greater incidence of thrombosis and embolism. Ventricular hypertrophy and dilatation results in a reduced cardiac reserve. A clinically unrecognized insulin resistance may become manifest during intensive care. Digoxin, theophylline and aminoglycosides, commonly with a low therapeutic spectrum, when administered on the basis of weight, may lead to dangerously high serum concentrations in the overweight.

At a weight of more than about 100 kg, it must generally be expected that the compensatory mechanisms of the body are exhausted and that there will be an increased susceptibility to additional disorders of homeostasis.