High altitude pulmonary edema - Revision history

Danbot: Add MedicationDose entry (nifedipine) with SMW annotations

2026-03-20T18:37:26Z

Add MedicationDose entry (nifedipine) with SMW annotations

@@ Línea 98: / Línea 98: @@
 **[[Nifedipine]] 30mg ER q12hr (or 20mg normal-release q8hr)<ref>Luks AM, McIntosh SE, Grissom CK, et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2014 Update. Wilderness & Environmental Medicine. 2014(25): S4–S14)</ref>
 ***May consider the other medications listed below that are usually used for prevention
 ==Disposition==

2021-05-22T22:50:40Z

Prevention

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	*[[Salmeterol]] 125 mcg inhaled BID		*[[Salmeterol]] 125 mcg inhaled BID
	*[[Acetazolamide]] 125mg BID for prevention of hypoxia		*[[Acetazolamide]] 125mg BID for prevention of hypoxia
			*[[Dexamethasone]] 8mg PO BID<ref>Maggiorini M, Brunner-La Rocca H-P, Peth S, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med. 2006;145(7):497-506.</ref>

	==See Also==		==See Also==

2021-05-22T22:46:21Z

Prevention

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	==Prevention==		==Prevention==
			*Slow ascent at a rate no more than 300-350m (1000ft) per day above 2500m (8000ft)<ref>Rosen JM. High Altitude Disease in Adults. www.uptodate.com. Version 14.1:2005. (On line review and treatment guidelines)</ref>
	*[[Nifedipine]] 20mg q8hr or 30mg ER q12hr while ascending is effective prophylaxis in patients with prior episodes of HAPE		*[[Nifedipine]] 20mg q8hr or 30mg ER q12hr while ascending is effective prophylaxis in patients with prior episodes of HAPE
	*[https://nizagara-online.net/tadalafil/ Tadalafil] 10mg BID 24hr prior to ascent '''OR''' [[Sildenafil]] 50mg q8hr		*[https://nizagara-online.net/tadalafil/ Tadalafil] 10mg BID 24hr prior to ascent '''OR''' [[Sildenafil]] 50mg q8hr

2021-05-22T22:32:11Z

Differential Diagnosis

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	*[[COPD]]		*[[COPD]]
	*[[MI]]		*[[MI]]
			*[[Pneumonia]]
			*[[PE]]
			*[[Pneumonitis]]
			*Pulmonary edema of any cause (cardiogenic, neurogenic, toxic, immersion, etc)

	{{High altitude DDX}}		{{High altitude DDX}}

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Evaluation

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 ***[[Tachypnea]]
 ***[[Tachycardia]]
 {{Expected SpO2 at altitude}}

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Evaluation

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	===Evaluation===		===Evaluation===
	*The Lake Louise Consensus Definition of HAPE<ref>Sutton JR, Coates G, Houston CS, eds. Hypoxia and Mountain Medicine: Proceedings of the 7th International Hypoxia Symposium, Held at Lake Louise, Canada, February 1991. 1st ed. Pergamon Press; 1992.</ref>		*The Lake Louise Consensus Definition of HAPE<ref>Sutton JR, Coates G, Houston CS, eds. Hypoxia and Mountain Medicine: Proceedings of the 7th International Hypoxia Symposium, Held at Lake Louise, Canada, February 1991. 1st ed. Pergamon Press; 1992.</ref>
	**At least two of the following symptoms: [[~~dyspnea~~]] at rest, [[~~cough~~]]~~, weakness~~ or decreased exercise performance~~, chest~~ tightness or congestion		**At least two of the following symptoms:
	**As well as two of the following signs: ~~crackles~~ or wheezing in at least one lung field~~, central~~ cyanosis~~, tachypnea, tachycardia~~		***[[Dyspnea]] at rest
			***[[Cough]]
			***Weakness or decreased exercise performance
			***Chest tightness or congestion
			**As well as two of the following signs:
			***Crackles or wheezing in at least one lung field
			***Central cyanosis
			***[[Tachypnea]]
			***[[Tachycardia]]

	{{Expected SpO2 at altitude}}		{{Expected SpO2 at altitude}}

2021-05-22T21:59:35Z

Evaluation

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	===Evaluation===		===Evaluation===
	*~~Clinical diagnosis~~		*The Lake Louise Consensus Definition of HAPE<ref>Sutton JR, Coates G, Houston CS, eds. Hypoxia and Mountain Medicine: Proceedings of the 7th International Hypoxia Symposium, Held at Lake Louise, Canada, February 1991. 1st ed. Pergamon Press; 1992.</ref>
			**At least two of the following symptoms: [[dyspnea]] at rest, [[cough]], weakness or decreased exercise performance, chest tightness or congestion
			**As well as two of the following signs: crackles or wheezing in at least one lung field, central cyanosis, tachypnea, tachycardia

	{{Expected SpO2 at altitude}}		{{Expected SpO2 at altitude}}

2021-05-22T21:54:39Z

Early

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	==Clinical Features==		==Clinical Features==
	===Early===		===Early===
	*Dry [[cough]], decreased exercise performance, [[dyspnea]] on exertion, localized rales		*Dry [[cough]], decreased exercise performance, prolonged exercise recover time, [[dyspnea]] on exertion, localized rales
	*Resting SaO2 is [[hypoxia\|very low]] for the expected altitude but patients often appear clinically better than their saturation (aids in diagnosis)		*Resting SaO2 is [[hypoxia\|very low]] for the expected altitude but patients often appear clinically better than their saturation (aids in diagnosis)
	*Easily desaturates with exertion		*Easily desaturates with exertion

2021-05-21T08:49:09Z

Background

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	*Preexisting respiratory infection (children)		*Preexisting respiratory infection (children)
	*Previous history of HAPE		*Previous history of HAPE

			===Pathophysiology===
			*Multiple pathways but thought to be due to an exaggerated pulmonary artery pressure elevation in response to hypoxia <ref>Bärtsch P. High altitude pulmonary edema. Med Sci Sports Exerc. 1999;31(1 Suppl):S23-27.</ref> and the following hypothesis:
			**Breakdown of the alveolar/endothelial barrier leading to increased pulmonary vascular endothelial permeability
			**Normal wedge pressure, which distinguishes this pathophysiology from heart failure <ref>Hultgren HN, Lopez CE, Lundberg E, Miller H. Physiologic studies of pulmonary edema at high altitude. Circulation. 1964;29(3):393-408.</ref>
			**Increased intra-cranial pressure which can lead to pulmonary edema <ref>Ducker TB, Simmons RL. Increased intracranial pressure and pulmonary edema. 2. The hemodynamic response of dogs and monkeys to increased intracranial pressure. J Neurosurg. 1968;28(2):118-123.</ref>

	==Clinical Features==		==Clinical Features==

2021-05-21T08:01:37Z

Background

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	*Noncardiogenic [[pulmonary edema]] due to increased microvascular pressure in the pulmonary circulation		*Noncardiogenic [[pulmonary edema]] due to increased microvascular pressure in the pulmonary circulation
	**Hypoxic pulmonary vasoconstriction leads to [[pulmonary hypertension]]		**Hypoxic pulmonary vasoconstriction leads to [[pulmonary hypertension]]
	*Most lethal of the altitude illnesses		*Most lethal of the altitude illnesses with mortality approaching 50% if descent is not completed in a timely manner <ref>Lobenhoffer HP, Zink RA, et al. High altitude pulmonary edema: analysis of 166 cases. In: Brendel W, Zink RA, editors. High Altitude Physiology and Medicine. New York, NT: Springer-Verlag; 1982. pp. 219–231</ref>
	*Occurs in <1/10,000 skiers in Colorado; 2-3% of Mt. McKinley climbers		*Occurs in <1/10,000 skiers in Colorado; 2-3% of Mt. McKinley climbers
	*Typical patient is strong and fit; may not have symptoms of [[altered mental status]] before onset of HAPE		*Typical patient is strong and fit; may not have symptoms of [[altered mental status]] before onset of HAPE