High Altitude Illnesses - Dr. Wedmore

Acute Mountain Sickness (AMS)

• HISTORICAL diagnosis  - feels like a bad hangover
• Altitude + headache + (dizziness or nausea/vomiting or insomnia or anorexia)
  

• Previous history of AMS most important predictor, followed by total height and speed of ascent.

• Tx - ASA, APAP, Acetazolamide 250mg PO BID treatment, Descent.

• Prophylaxis
  

1. Acetazolamide 125mg PO BID 24hrs PTA x 72 hours,
   
2. Ibuprofen
   
3. Ginkgo Biloba 120mg PO BID (for your hippie/granola friends)
4. Dexamethasone 4mg PO q8h

High Altitude Cerebral Edema (HACE)

• # 1 cause of death at altitude
• AMS + progressive neuro findings/ataxia

• Tx - Descent, O2, Dexamethasone 8mg x1, then 4mg q6h

High Altitude Pulmonary Edema (HAPE)

• Different pathophys than Cardiac pulm edema
  
• Normal PCWP - not a fluid overload problem, rather a fluid distribution problem, NO lasix!!

• Hypoxia causes vasoconstriction causing leaking capillaries which worsens hypoxia and vasoconstriction
• HAPE death spiral negative feedback loop. Takes 2-4 days
• Cough, dyspnea, fatigue, leukocytosis common
  

• 50% overlap of HACE and HAPE

• Tx - Descent resolves symptoms quickly (min 1000m), 02, nifedipine

• Prophylaxis - Nifedipine 30-60mg QD, Salmeterol 125mg inh q12h, dexamethasone, diamox if mild,  viagra/cialis