High Altitude Pulmonary Edema (HAPE)
HAPE is a fluid build-up in the lungs. Cases seen at altitudes as low as 8,000 ft. (e.g., Colorado ski resorts) HAPE: Some Basics Can occur in people with no other symptoms of altitude illness (AMS or HACE) Can occur up to 4-5 days after arrival at altitude HAPE is potentially fatal if not recognized and treated appropriately.
HAPE: How To Recognize The Problem Decreased exercise performance Long time needed to recover with breaks. Dry cough (becomes wet in severe cases) Profound fatigue Out of breath with simple activities Blue lips and finger tips
Preventing High Altitude Illness
Preventive Steps That Don t Require Taking Medicine Undertake a gradual ascent!!! Above 10,000 ft: limit increases in sleeping elevation to 1,000 to 1,500 ft per night; Rest days every 3-4 days or with large gains in elevation Minimize alcohol use Avoid narcotic pain medications Avoid overexertion
An Ascent Profile: Everest Base Camp Sleeping or Maximum Elevation for First 6 Days of Trip Elevation (ft) 20,000 18,000 16,000 14,000 12,000 10,000 14,464 14,464 12,660 11,283 11,283 9,315 8,000 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Everest Base Camp (First 6 Days of Trek to 17,593 ft)
A Faster Ascent Profile: Kilimanjaro Machame Route Sleeping or Maximum Elevation for First 6 Days of Trip Elevation (ft) 20,000 18,000 16,000 14,000 12,000 10,000 19,335 18,499 16,334 15,088 12,595 14,464 14,464 12,660 9,840 11,283 11,283 8,000 9,315 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Kilimanjaro Everest Base Camp (First 6 Days of Trek to 17,593 ft)
A Key Point on Trip Planning Be Flexible!!!
Prophylactic Medications: Who Should Take Them People with a prior history of altitude illness People who must travel to over 10,000 feet on their first day (e.g., flying into Lhasa, Cuzco or La Paz) People who need to push a fast rate of ascent after the first day (e.g., S&R)
Prophylactic Medications: Two Accepted Options Acetazolamide Dose: 125 mg every 12 hrs Caution in people with sulfa allergy Side effects: increased urination; tingling in extremities Dexamethasone Dose: 4 mg every 12 hrs or 2 mg every 6 hours Does not affect acclimatization Usually reserved for those who do not tolerate acetazolamide
Extra Prevention for People With a History of HAPE Nifedipine: 30 mg of the long-acting version twice a day Alternatives: Tadalafil (Cialis) or Sildenafil (Viagra) These are not used for prevention unless the person has had HAPE before
Prophylactic Medications: How to Take Them Start taking the night before or the day you begin your ascent May start at any point along the ascent Stop taking them when you start to descend or after many days at same/peak altitude
Treating High Altitude Illness
De sce n tm ake st hin gs Bet ter The Key Principle of Treatment
Who Actually Needs To Descend? Severe Acute Mountain Sickness High Altitude Cerebral Edema (HACE) High Altitude Pulmonary Edema (HAPE)
If Descent is Not Possible: Supplemental Oxygen Oxygen Concentrator Oxygen Tanks Gamow Bag
How The Gamow Bag Works Altimeter Watch Outside the Bag 14,330 ft Inside the Bag 10,720 ft
Most People With AMS Do Not Require Descent Stop ascending Aspirin, tylenol, ibuprofen for headache (no narcotics) Drink plenty of fluids Consider acetazolamide: (250 mg twice a day) Okay to go higher if symptoms resolve; descend if no improvement
Pharmacologic Treatment Of Severe Altitude Illness * Severe AMS Dexamethasone 4 mg every 6 hrs or Acetazolamide 250 mg every 12 hrs HACE Dexamethasone 8 mg once then 4 mg every 6 hrs HAPE Nifedipine (sustained release) every 12 hours * For treatment in the field. The approach may differ at a health facility
Some Other Treatment Principles Never go higher in the face of symptoms of altitude illness!!!
Avoid This Disease!!! Summit Fever
Some Common Questions
A Question Where can I get the high altitude medications?
Obtaining The High Altitude These medications require a prescription that can be obtained from: - - Your regular physicians Travel clinic Watch for one of two problems in your efforts to obtain the medicines: - - Medications Reluctance to prescribe them Ignorance about the correct doses, how to use them
A Question If I ve been sick at altitude before, will I get sick again on a future trip
Prior responses at altitude are a good, but not perfect predictor of future responses
A Question If I make some trips to high altitude prior to my planned trip will this help prevent altitude illness?
It All Depends... How high you go How many trips you make How long you stay up high How close to your planned trip
A Question I m in great physical shape... Doesn t this protect against getting altitude illness?
Being In Good Shape Is NOT Protective Against AMS =
A Question I can t sleep at altitude... What medicines are safe for me to take at night?
Sleep Aids At High Altitude Shown to be safe and effective - Acetazolamide (Diamox) - Temazepam (Restoril) - Zolpidem (Ambien) and Zaleplon (Sonata) Not studied but probably safe and effective: - Diphenhydramine (Benadryl) - Eszopiclone (Lunesta) Do NOT use: - Narcotics - Diazepam (Valium)
The Take-Home Messages Know how to recognize the symptoms of altitude illness when traveling up high Slow ascents are the best way to prevent altitude illness The altitude wins... you have to listen to your body when you don t feel good
Questions? andrew_luks@yahoo.com aluks@u.washington.edu