Highest BMI you have seen?

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Raryn said:
Exactly.

Patient barely had any stumps - was basically pelvis on wheelchair and thats it. Was also quite round.
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so is using the regular bmi formula underestimate BMI or did this calculation incorporate the bilateral AKAs.
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libertyyne said:
so is using the regular bmi formula underestimate BMI or did this calculation incorporate the bilateral AKAs.
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BMI is just weight/height^2. So using the regular BMI formula on someone without legs would overestimate their BMI - given that height goes down a lot more than weight does.
 
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Raryn said:
BMI is just weight/height^2. So using the regular BMI formula on someone without legs would overestimate their BMI - given that height goes down a lot more than weight does.
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I feel like a path specimen would have the highest BMI of all. Only a single layer of cells tall.
 
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sella.turcica said:
How much does a cell weigh?
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A skin cell is about 3 x 10^-5 m across. If we estimate its density to be about that of water, then it should weigh about 2.7 x 10^-11 kg. Plug this into the formula for BMI and we see that a single cell, by itself, has a BMI of 0.03. Two cells side-by-side would have a BMI of 0.06 and so on.

Thus, we can see a sheet of cells needs to be only about 10cm wide before its BMI > 100.
 
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DrSnips said:
A skin cell is about 3 x 10^-5 m across. If we estimate its density to be about that of water, then it should weigh about 2.7 x 10^-11 kg. Plug this into the formula for BMI and we see that a single cell, by itself, has a BMI of 0.03. Two cells side-by-side would have a BMI of 0.06 and so on.

Thus, we can see a sheet of cells needs to be only about 10cm wide before its BMI > 100.
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upload_2019-1-21_20-57-49.png
 
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I mean that’s an impressive body weight for someone missing half their body to be fair.
 
Some of these people had to be prader willis
 
DrSnips said:
107. Guy was on a ventilator in the ICU due to obesity hypoventilation syndrome. The ventilator could not ventilate his chest -- he was too heavy. We called the local zoo to try to get a ventilator for larger animals like bison, but the patient expired before this could be obtained.
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Oh my.
 
Saw a guy today with BMI of 56 post having a gastric sleeve. Guy reported eating small meals and feeling full, so naturally he just eats meals every 2 hours or so. When the doctor asked him to describe his "small" meals, they were anything but.
 
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For some insight into how someone gets that big, I'd suggest reading The Elephant in the Room: One Fat Man's Quest to Get Smaller in a Growing America
by Tommy Tomlinson. Pulitzer-finalist and a journalist who was up to 460 lb before going on a weight loss journey. I've only read a review thus far and it sounds interesting .
 
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LizzyM said:
For some insight into how someone gets that big, I'd suggest reading The Elephant in the Room: One Fat Man's Quest to Get Smaller in a Growing America
by Tommy Tomlinson. Pulitzer prize winning journalist who was up to 460 lb before going on a weight loss journey. I've only read a review thus far and it sounds interesting .
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Found my next book after Thinking: Fast and Slow and Rich Dad, Poor Dad.
 
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LizzyM said:
For some insight into how someone gets that big, I'd suggest reading The Elephant in the Room: One Fat Man's Quest to Get Smaller in a Growing America
by Tommy Tomlinson. Pulitzer-finalist and a journalist who was up to 460 lb before going on a weight loss journey. I've only read a review thus far and it sounds interesting .
Click to expand...
Or watch "My 600 lb Life"
 
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Met a 100+ BMI pain management pt today

That’s when I realize that pain med ain’t for me
 
Not the highest, but quite impressive:

Upper 30s in a 10 year old boy
 
Ya know, I’ve had some large patients but I don’t recall ever discusssing their BMIs.
 
BMI of 89 and giving birth. Guess who had to hold the fat back..... This gal.
 
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RNthenDoc said:
I can smell these posts
:depressed::dead:
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Yeah. We had a really sad case my general surgery colleagues told me about. A woman in her 20s who had recurrent thigh ulcers from them rubbing together and she was too big to see the inside of her thighs. She would know she had a new ulcer by the smell of rotting flesh.


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OrthoTraumaMD said:
Yeah. We had a really sad case my general surgery colleagues told me about. A woman in her 20s who had recurrent thigh ulcers from them rubbing together and she was too big to see the inside of her thighs. She would know she had a new ulcer by the smell of rotting flesh.


Sent from my iPhone using SDN mobile
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Okay, there goes my Sunday afternoon burger.....:hungover:
 
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OrthoTraumaMD said:
Yeah. We had a really sad case my general surgery colleagues told me about. A woman in her 20s who had recurrent thigh ulcers from them rubbing together and she was too big to see the inside of her thighs. She would know she had a new ulcer by the smell of rotting flesh.


Sent from my iPhone using SDN mobile
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That's just disgusting
 
OrthoTraumaMD said:
Yeah. We had a really sad case my general surgery colleagues told me about. A woman in her 20s who had recurrent thigh ulcers from them rubbing together and she was too big to see the inside of her thighs. She would know she had a new ulcer by the smell of rotting flesh.


Sent from my iPhone using SDN mobile
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When you were debriding did you get the urge to just YEET some of the excess adipose away?

Because that’s what it makes me want to do.
 
RNthenDoc said:
When you were debriding did you get the urge to just YEET some of the excess adipose away?

Because that’s what it makes me want to do.
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I was not involved personally in the case. It was general surgery and they told me about it.
Generally you don’t want to randomly take out globs of fat (though it is tempting) because it creates dead space that can fill up and get infected postop.


Sent from my iPhone using SDN mobile
 
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Had an 1100 lb guy in his 20s that was probably under 6 ft, so BMI over 150. We were asked to place a g tube after GI failed to see the scope light while attempting to do a PEG.

I declined.
 
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ThoracicGuy said:
Had an 1100 lb guy in his 20s that was probably under 6 ft, so BMI over 150. We were asked to place a g tube after GI failed to see the scope light while attempting to do a PEG.

I declined.
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Why does he need a peg? Sounds like he has enough nutrition onboard to last him for the next ten years
 
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Psai said:
Why does he need a peg? Sounds like he has enough nutrition onboard to last him for the next ten years
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That's what I said... something about living off the fat of the land...

nimbus said:
Why did he need a g tube?
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He had respiratory failure and ENT put a trach in him. So the ICU team wanted to get nutrition in him. I have no clue why they even bothered to consult GI for a PEG. I also have no clue why GI bothered to even scope him. There's no way GI would even have a chance to see the scope light to know where to stick for the PEG, much less have a device big enough to work.
 
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110 BMI, 750 pound male with Pickwickian syndrome. My first day on the job as a physical therapist, orders were for chest percussion/physical therapy/postural drainage!
 
samac said:
Ya know, I’ve had some large patients but I don’t recall ever discusssing their BMIs.
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No need to discuss it. Epic has it centered on the top of the screen.
 
MSTPlease said:
Maybe 1 of the patients mentioned in this thread had PW and that's probably an overestimate.
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What percentage of people with BMIs over 70 are PW? I bet its significantly higher than youd expect. Its the most common syndromic form of obesity with a conservative estimate at 1 in 25k. There are about 450k in the world.
 
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MSTPlease said:
No need to discuss it. Epic has it centered on the top of the screen.
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Our EMR doesn’t put it front and center, you have to go to a specific place in the chart and it’s just not clicked very often.
 
99 in the MICU, diuresed down to 72 when we transferred to the floor. :wideyed:
 
Today. BMI of 59. Patient was HYPERthyroid. Yes, that is correct, hyper not hypo. Dr was dumbfounded, and said she should have been losing weight with her condition and he’s not sure why she is not. Patient said she’s been big her entire life, and she doesnt feel that she’s overweight, because she’s been big as long as she can remember. Her BMI again, is 59. We had to treat the hyperthyroidism because of the other problems it was causing, but the doctor told the patient she has to lose weight anyway. Patient denies that she has to lose weight. Her A1C was 6.4 and her fasting glucose was 124. I suppose she’s on a mission to be diabetic. (We were impressed she isn’t yet...)
 
Premed2295 said:
Today. BMI of 59. Patient was HYPERthyroid. Yes, that is correct, hyper not hypo. Dr was dumbfounded, and said she should have been losing weight with her condition and he’s not sure why she is not. Patient said she’s been big her entire life, and she doesnt feel that she’s overweight, because she’s been big as long as she can remember. Her BMI again, is 59. We had to treat the hyperthyroidism because of the other problems it was causing, but the doctor told the patient she has to lose weight anyway. Patient denies that she has to lose weight. Her A1C was 6.4 and her fasting glucose was 124. I suppose she’s on a mission to be diabetic. (We were impressed she isn’t yet...)
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I'm only an M1, so I'm just genuinely curious:

Could her thyroid be healthy and doing its job, with her hyperthyroidism as a symptom of another underlying pathology? Any chance of a pituitary or hypothalamic issue?
 
PipetteDreams said:
I'm only an M1, so I'm just genuinely curious:

Could her thyroid be healthy and doing its job, with her hyperthyroidism as a symptom of another underlying pathology? Any chance of a pituitary or hypothalamic issue?
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No.

Hyperthyroidism is too much thyroid hormone for the specific person - as measured by a TSH. A bigger person needs more hormone produced than a smaller one, but the relative concentration of free hormone stays the same, as does the regulatory system (TSH).

Her metabolism was increased by the thyrotoxicosis but it's entirely likely her appetite was too. She out ate the increased metabolism.

It happens.
 
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Raryn said:
No.

Hyperthyroidism is too much thyroid hormone for the specific person - as measured by a TSH. A bigger person needs more hormone produced than a smaller one, but the relative concentration of free hormone stays the same, as does the regulatory system (TSH).

Her metabolism was increased by the thyrotoxicosis but it's entirely likely her appetite was too. She out ate the increased metabolism.

It happens.
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Imagine if she was hypothyroid
 
Amba said:
GF had someone with BMI 92 for some type of Ob/Gyn surgical procedure
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Similar...our lady was a bit lower (I want to say 70s?) only she also had a massive hernia throughout the pannus, such that there were intestines above the midfemurs on CT scan. It was...not fun...retracting for a TVH around that. Nice lady, though.
 
Raryn said:
No.

Hyperthyroidism is too much thyroid hormone for the specific person - as measured by a TSH. A bigger person needs more hormone produced than a smaller one, but the relative concentration of free hormone stays the same, as does the regulatory system (TSH).

Her metabolism was increased by the thyrotoxicosis but it's entirely likely her appetite was too. She out ate the increased metabolism.

It happens.
Click to expand...

I see - thanks for the thorough response!
 
PipetteDreams said:
I'm only an M1, so I'm just genuinely curious:

Could her thyroid be healthy and doing its job, with her hyperthyroidism as a symptom of another underlying pathology? Any chance of a pituitary or hypothalamic issue?
Click to expand...

I’m an M1 and asked my preceptor a similar question. In short, no. He told me that pituitary issues are exceedingly rare, he’s seen about 3 in his 30 year career in endocrinology. She should have been losing weight, despite the large appetite due to her high thyroid function, but she wasn’t and he said it would be hard for her to loose weight on the medications but she has to try seeing as she’s about 1 cookie away from full on diabetes.

Of course, if you ask the patient she doesnt eat large portions and doesnt have a big appetite. Of course her body seems to be telling a different story.
 
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Premed2295 said:
I’m an M1 and asked my preceptor a similar question. In short, no. He told me that pituitary issues are exceedingly rare, he’s seen about 3 in his 30 year career in endocrinology. She should have been losing weight, despite the large appetite due to her high thyroid function, but she wasn’t and he said it would be hard for her to loose weight on the medications but she has to try seeing as she’s about 1 cookie away from full on diabetes.

Of course, if you ask the patient she doesnt eat large portions and doesnt have a big appetite. Of course her body seems to be telling a different story.
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Oh and if it makes you feel any better, he told me that it was a good question to ask in terms of my clinical thinking and understanding of feedback loops, but that in practice that doesnt happen.
 
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