high-altitude pulmonary edema
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Introduction
Etiology:
- rapid ascent to > 14,000 feet in elevation.
- hypoxic pulmonary vasoconstriction
- cold weather & exertion contribute
Epidemiology
- incidence is 0.5-10% among mountaineers
- incidence is 60% on re-exposure of susceptible individuals to high altitudes
Pathology
- non-cardiogenic pulmonary edema
- leakage of fluid & hemorrhage into the alveolar spaces
Clinical manifestations
- symptoms appear 24-36 hours after ascent
- symptom onset generally insidious
- dyspnea
- dyspnea on exertion
- dyspnea at rest is key feature[2]
- cough
- tachynea
- tachycardia
- crackles or wheezing
- variable
- fatigue, nausea/vomiting, sleep disorder, frothy sputum, hemoptysis
- altered mental status
- somnolence
* left ventricular failure is NOT a manifestation.
Radiology
- chest X-ray shows patchy infiltrates which resolve 6-48 hours after return to sea level or supplemental oxygen therapy
Management
- supplemental oxygen
- furosemide
- vasodilator:
- nifedipine (effective for prevention)
- phosphodiesterase-5 inhibitor
- acetazolamide & dexamethasone are not useful
- return to lower elevation