title: How 40 kilograms of fluid retention can be overlooked: two case reports.
abstract: BACKGROUND
  With a rising incidence of severe obesity in developed nations, heart failure, a well-recognised co-morbidity, is becoming more common.
  
  
  METHODS
  We describe two recent patients encountered, a 64 year old and a 42 year old, who are both severely obese and presented with fluid retention of approximately 40 kilograms. Assessment revealed that the explanation of the gross clinical features were relatively subtle cardiac abnormalities. These cases illustrate how fluid retention in severe obesity can differ from that seen in 'traditional' heart failure in terms of clinical assessment and management.
  
  
  CONCLUSIONS
  Severe obesity can result in insidious fluid retention, which can be easily overlooked until large volumes of fluid have accumulated. Cardiac abnormalities are usually found in these patients, but may be relatively subtle, leading to current debate in the definition and classification of heart failure. These scenarios are increasingly being encountered in clinical practice. Recognition, assessment and treatment of the 'clinical syndrome of heart failure' in severe obesity is often difficult.
authors.affiliation: East London Obesity Service (c/o Dr Simon Coppack), Centre for Diabetes and Metabolic Medicine, Barts and The London School of Medicine, London, E1 2AT, United Kingdom. honshing@gmail.com.
authors.forename: Hon Shing
authors.initials: HS
authors.lastname: Ong
authors.forename: Candy Wing-Chiu
authors.initials: CW
authors.lastname: Sze
authors.forename: Tat Woon
authors.initials: TW
authors.lastname: Koh
authors.forename: Simon Ward
authors.initials: SW
authors.lastname: Coppack