HIGH ALTITUDE PULMONARY EDEMA (HAPE) • High altitude disease that kill most people • Incidence: severe cases 1-5% but increase lung water seen in 75% of climbers • Early signs are weakness and shortness of breath that evolves in tachypnea, tachycardia, and severe hypoxia THERAPY 1) Rapid Descent 2) Oxygen 4-6/l 3) Nifedepine 10 mg po then 30mgSR q12-24 hours 4) Portable hyperbaric chamber if descent not possible 5) Sildenafil (Viagra) 50 TID: Lowers pulmonary artery pressures and improves oxygenation without systemic hypotension 6) Increasing data that acetazolimide may also help HAPE Prevention: Patients who have suffered from HAPE are prone to recurrence 1) Slower ascent 2) Nifedipine 20-30 mg q12 hours 3) Increasing evidence that steroids may prevent HAPE Etiology: • Patients prone to HAPE have exaggerated pulmonary artery pressure to hypoxia • Uneven blood flow to parts of the lung may lead to stress breakdown of endothelium and fluid leak Dr. Thomas DeLoughery @Bloodman #High #Altitude #Pulmonary #Edema #HAPE #diagnosis #management
