Diferencia entre revisiones de «Chronic mountain sickness»
(Expand with concise EM-focused content: clinical features, evaluation, management including phlebotomy) |
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==Background== | ==Background== | ||
*Excessive [[polycythemia]] | *Excessive [[polycythemia]] at altitude (Hgb >20 g/dL in men, >19 in women) | ||
*Occurs in | *Occurs in long-term high-altitude residents (typically >3,000m) who develop loss of ventilatory acclimatization | ||
*Risk factors: [[COPD]], [[obstructive sleep apnea]], impaired respiratory drive, obesity, advancing age | |||
*Also known as Monge disease | |||
==Clinical Features== | ==Clinical Features== | ||
*[[Headache]] | *[[Headache]], dizziness, difficulty concentrating | ||
* | *[[Fatigue|Drowsiness]], exercise intolerance | ||
*Impaired peripheral circulation | *Impaired peripheral circulation: cyanosis, digital clubbing | ||
*[[ | *Paresthesias | ||
*[[Pulmonary hypertension]] may develop | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*CBC: markedly elevated hematocrit/hemoglobin | |||
*Pulse oximetry: low SpO2 at altitude (lower than expected) | |||
*ABG: chronic respiratory alkalosis with metabolic compensation | |||
*Echocardiography if concern for pulmonary hypertension | |||
==Management== | ==Management== | ||
*Phlebotomy | *'''Definitive:''' Descent to lower altitude (curative) | ||
* | *Phlebotomy for symptomatic relief (target Hgb <18) | ||
* | *Supplemental oxygen, especially during sleep | ||
*[[Acetazolamide]] 250 mg BID may improve ventilatory drive | |||
*Treat contributing conditions (CPAP for OSA, bronchodilators for COPD) | |||
==Disposition== | |||
*Outpatient management in most cases with referral to primary care | |||
*Recommend relocation to lower altitude for definitive treatment | |||
==See Also== | ==See Also== | ||
*[[High | *[[Acute mountain sickness]] | ||
*[[High altitude cerebral edema]] | |||
*[[High altitude pulmonary edema]] | |||
*[[Polycythemia]] | |||
==References== | ==References== | ||
Revisión actual - 01:19 21 mar 2026
Background
- Excessive polycythemia at altitude (Hgb >20 g/dL in men, >19 in women)
- Occurs in long-term high-altitude residents (typically >3,000m) who develop loss of ventilatory acclimatization
- Risk factors: COPD, obstructive sleep apnea, impaired respiratory drive, obesity, advancing age
- Also known as Monge disease
Clinical Features
- Headache, dizziness, difficulty concentrating
- Drowsiness, exercise intolerance
- Impaired peripheral circulation: cyanosis, digital clubbing
- Paresthesias
- Pulmonary hypertension may develop
Differential Diagnosis
High Altitude Illnesses
- Acute mountain sickness
- Chronic mountain sickness
- High altitude cerebral edema
- High altitude pulmonary edema
- High altitude peripheral edema
- High altitude retinopathy
- High altitude pharyngitis and bronchitis
- Ultraviolet keratitis
Evaluation
- CBC: markedly elevated hematocrit/hemoglobin
- Pulse oximetry: low SpO2 at altitude (lower than expected)
- ABG: chronic respiratory alkalosis with metabolic compensation
- Echocardiography if concern for pulmonary hypertension
Management
- Definitive: Descent to lower altitude (curative)
- Phlebotomy for symptomatic relief (target Hgb <18)
- Supplemental oxygen, especially during sleep
- Acetazolamide 250 mg BID may improve ventilatory drive
- Treat contributing conditions (CPAP for OSA, bronchodilators for COPD)
Disposition
- Outpatient management in most cases with referral to primary care
- Recommend relocation to lower altitude for definitive treatment