eMedicine Specialties > Pulmonology > Altitude Edema and Lung Diseases

Pulmonary Edema, High-Altitude: Follow-up

Author: Rohit Goyal, MD, Fellow, Division of Pulmonary Medicine, Lenox Hill Hospital, New York University School of Medicine
Coauthor(s): Mir Omar Ali, MD, Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital, New York University; Samia Qazi, MD, Director of the Travel and Immunization Clinic, Nassau County Medical Center; Assistant Professor, Department of Internal Medicine, State University of New York Health Science Center at Stony Brook; Laurie Ward, MD, Chief, Co-Director of Travel and Immunization Clinic, Nassau County Medical Center; Assistant Professor, Department of Internal Medicine, Division of Primary Care, State University of New York at Stony Brook; Qazi Qaisar Afzal, MD, Clinical Instructor, Department of Medicine, State University of New York at Stony Brook; Mir Mustafa Ali, Deccan College of Medical Sciences, Owaisi Hospital and Research Center, Princess Esra Hospital, India; Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Contributor Information and Disclosures

Updated: Sep 17, 2009

Follow-up

Further Inpatient Care

  • Admission to a hospital is warranted for significant arterial desaturation and clinical deterioration despite outpatient management of high-altitude pulmonary edema (HAPE).

Deterrence/Prevention

  • The following measures may prevent further episodes of high-altitude pulmonary edema (HAPE) in patients with a history of altitude illness:
    • Avoiding heavy exertion at high altitude
    • Slow ascent
    • Avoiding abrupt ascent to sleeping elevations higher than 3000 m: If possible, spend 2 nights at altitudes of 2500-3000 m before further ascent.
    • Avoiding alcohol and sedatives

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • In addition to immunizations and chemoprophylaxis, discussion regarding acute mountain sickness and high-altitude pulmonary edema (HAPE) should be included as a part of pretravel advice in high-risk travelers. Travelers should be questioned about previous episodes of mountain sickness, coexistent pulmonary and cardiac problems, and the desired altitude to be attained. Failure to provide the necessary advice or medication may pose future liability for the healthcare provider.
 


More on Pulmonary Edema, High-Altitude

Overview: Pulmonary Edema, High-Altitude
Differential Diagnoses & Workup: Pulmonary Edema, High-Altitude
Treatment & Medication: Pulmonary Edema, High-Altitude
Follow-up: Pulmonary Edema, High-Altitude
References
[ CLOSE WINDOW ]

References

  1. Fischer R, Lang SM, Bergner A, Huber RM. Monitoring of expiratory flow rates and lung volumes during a high altitude expedition. Eur J Med Res. Nov 16 2005;10(11):469-74. [Medline].

  2. Eldridge MW, Braun RK, Yoneda KY, Walby WF. Effects of altitude and exercise on pulmonary capillary integrity: evidence for subclinical high-altitude pulmonary edema. J Appl Physiol. Mar 2006;100(3):972-80. [Medline].

  3. Leshem E, Pandey P, Shlim DR, Hiramatsu K, Sidi Y, Schwartz E. Clinical features of patients with severe altitude illness in Nepal. J Travel Med. Sep-Oct 2008;15(5):315-22. [Medline].

  4. Hartmann G, Tschop M, Fischer R, et al. High altitude increases circulating interleukin-6, interleukin-1 receptor antagonist and C-reactive protein. Cytokine. Mar 2000;12(3):246-52. [Medline].

  5. Grunig E, Mereles D, Hildebrandt W, et al. Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema. J Am Coll Cardiol. Mar 15 2000;35(4):980-7. [Medline].

  6. Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Thomas SH, Harris NS. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Chest. Apr 2007;131(4):1013-8. [Medline].

  7. Fagenholz PJ, Gutman JA, Murray AF, Harris NS. Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt Med Biol. Summer 2007;8(2):139-46. [Medline].

  8. [Best Evidence] Maggiorini M, Brunner-La Rocca HP, Peth S, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med. Oct 3 2006;145(7):497-506. [Medline].

  9. [Guideline] Hill DR, Ericsson CD, Pearson RD, et al. The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Infect Dis. Dec 15 2006;43(12):1499-539. [Medline].

  10. [Guideline] Rice SG. Medical conditions affecting sports participation. Pediatrics. Apr 2008;121(4):841-8. [Medline].

  11. Bärtsch P, Maggiorini M, Ritter M, Noti C, Vock P, Oelz O. Prevention of high-altitude pulmonary edema by nifedipine. N Engl J Med. Oct 31 1991;325(18):1284-9. [Medline].

  12. van Patot MC, Leadbetter G 3rd, Keyes LE, Maakestad KM, Olson S, Hackett PH. Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness. High Alt Med Biol. Winter 2008;9(4):289-93. [Medline].

  13. Bärtsch P. High altitude pulmonary edema. Med Sci Sports Exerc. Jan 1999;31(1 Suppl):S23-7. [Medline].

  14. Bärtsch P. High altitude pulmonary edema. Respiration. 1997;64(6):435-43. [Medline].

  15. Goetz AE, Kuebler WM, Peter K. High-altitude pulmonary edema. N Engl J Med. Jul 18 1996;335(3):206-7. [Medline].

  16. Hackett PH, Rennie D, Levine HD. The incidence, importance, and prophylaxis of acute mountain sickness. Lancet. Nov 27 1976;2(7996):1149-55. [Medline].

  17. Klocke DL, Decker WW, Stepanek J. Altitude-related illnesses. Mayo Clin Proc. Oct 1998;73(10):988-92; quiz 992-3. [Medline].

  18. Krieger BP, de la Hoz RE. Altitude-related pulmonary disorders. Crit Care Clin. Apr 1999;15(2):265-80, viii. [Medline].

  19. Naeije R. Pulmonary circulation at high altitude. Respiration. 1997;64(6):429-34. [Medline].

  20. Nayak NC, Roy S, Narayanan TK. Pathologic features of altitude sickness. Am J Pathol. Sep 1964;45:381-91. [Medline].

  21. Schoene RB. Lung disease at high altitude. Adv Exp Med Biol. 1999;474:47-56. [Medline].

  22. Schoene RB, Hackett PH, HornBein TF. High altitude. In: Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine. Vol 2. Philadelphia, Pa: WB Saunders; 2000:2062-98.

  23. Singh I, Khanna PK, Srivastava MC, Lal M, Roy SB, Subramanyam CS. Acute mountain sickness. N Engl J Med. Jan 23 1969;280(4):175-84. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

high-altitude pulmonary edema, mountain sickness, altitude illness, HAPE, high-altitude illness, cerebral edema, acute mountain sickness, retinal hemorrhages, peripheral edema, noncardiogenic pulmonary edema

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Rohit Goyal, MD, Fellow, Division of Pulmonary Medicine, Lenox Hill Hospital, New York University School of Medicine
Rohit Goyal, MD is a member of the following medical societies: American College of Chest Physicians, American Medical Association, and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Mir Omar Ali, MD, Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital, New York University
Mir Omar Ali, MD is a member of the following medical societies: American College of Physicians and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Samia Qazi, MD, Director of the Travel and Immunization Clinic, Nassau County Medical Center; Assistant Professor, Department of Internal Medicine, State University of New York Health Science Center at Stony Brook
Samia Qazi, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Laurie Ward, MD, Chief, Co-Director of Travel and Immunization Clinic, Nassau County Medical Center; Assistant Professor, Department of Internal Medicine, Division of Primary Care, State University of New York at Stony Brook
Laurie Ward, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, and National Kidney Foundation
Disclosure: Nothing to disclose.

Qazi Qaisar Afzal, MD, Clinical Instructor, Department of Medicine, State University of New York at Stony Brook
Qazi Qaisar Afzal, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Mir Mustafa Ali, Deccan College of Medical Sciences, Owaisi Hospital and Research Center, Princess Esra Hospital, India
Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: sepracor Ownership interest None

Medical Editor

Gregory Tino, MD, Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital
Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

,, Kathy Roarty Placeholder
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.