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Educate travelers to recognize the symptoms -- High-altitude pulmonary edema: How to prevent, how to manage.

Article Excerpt
Byline: David L. Klocke, MD

Abstract: High-altitude pulmonary edema (HAPE) is a potentially fatal illness that may occur at moderately high altitudes (8000 to 10,000 feet), such as those at ski resorts, but higher altitudes pose much greater risks. Presenting symptoms and signs include exertional dyspnea; dry cough; fatigue; weakness; tachycardia; tachypnea; and pink-tinged, frothy sputum. Patients may also have coexisting acute mountain sickness, characterized by headache and malaise, or high-altitude cerebral edema, which may cause nausea, vomiting, lassitude, and ataxia. The treatment of HAPE includes descent, by medical evacuation if necessary; supplemental oxygen; and nifedipine. Preventive measures include gradual ascent, awareness of the possible symptoms, and immediate descent if symptoms occur. (J Respir Dis. 2007;28(11):510-514)

High-altitude pulmonary edema (HAPE) is an uncommon but serious cause of morbidity and mortality in travelers to high altitudes. It is the most frequent cause of death among altitude-related illnesses.1 With the advent of convenient air travel to many destinations, travelers can depart from a sea level location and within hours arrive at altitudes of approximately 10,000 feet in the western United States, or 13,000 feet or more in South America and elsewhere.

Approximately 1 in 10,000 visitors to Colorado ski resorts (elevation about 10,000 feet) experience the serious symptoms of HAPE.1 The frequency of HAPE increases exponentially with increasing altitude, affecting about 1 in 50 climbers on Mount McKinley in Alaska (elevation at summit about 20,000 feet).2 Recognition of HAPE in its early stages is imperative-untreated, this illness is uniformly fatal. However, the symptoms of HAPE can be easily confused with those of other, more common illnesses, thus complicating the diagnosis.

In this article, I review the clinical presentation, diagnosis, and treatment of HAPE and offer preventive pretravel advice to be shared with persons bound for high altitudes. I also briefly discuss the pathophysiological mechanisms of this condition (see "The pathophysiology of high-altitude pulmonary edema").

Typical findings

Usually, HAPE occurs at elevations greater than 8000 feet (for persons normally residing at 3000 feet or less), and it presents most frequently during the second night at high altitude. The classic victim is young and well-conditioned; there is a slightly greater incidence in men than in women.3 Persons with a history of HAPE are...

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