HAPE - High Altitude Pulmonary Edema
Another form of severe altitude illness is High Altitude Pulmonary
Edema, a potentially deadly condition that develops because the lung
arteries develop excessive pressure in response to low oxygen, resulting
in overflow of fluid in the lungs. Though it often occurs with AMS, it
is not felt to be related and the classic signs of AMS may be absent.
Signs and symptoms of HAPE include any of the following:
- Extreme fatigue
- Breathlessness at rest
- Fast, shallow breathing
- Cough, possibly productive of frothy or pink sputum
- Gurgling or rattling breaths
- Chest tightness, fullness, or congestion
- Blue or gray lips or fingernails
- Drowsiness
HAPE usually occurs on the second night after an ascent, and is more
frequent in young, fit climbers or trekkers.
In some persons, the hypoxia of high altitude causes constriction of
some of the blood vessels in the lungs, shunting all of the blood
through a limited number of vessels that are not constricted. This
dramatically elevates the blood pressure in these vessels and results in
a high-pressure leak of fluid from the blood vessels into the lungs.
Exertion and cold exposure can also raise the pulmonary blood pressure
and may contribute to either the onset or worsening of HAPE.
Immediate descent is the treatment of choice for HAPE; unless oxygen is
available delay may be fatal. Descend to the last elevation where the
victim felt well upon awakening. Descent may be complicated by extreme
fatigue and possibly also by confusion (due to inability to get enough
oxygen to the brain); HAPE frequently occurs at night, and may worsen
with exertion. These victims often need to be carried.
It is common for persons with severe HAPE to also develop HACE,
presumably due to the extremely low levels of oxygen in their blood
(equivalent to a continued rapid ascent).
HAPE usually resolves rapidly with descent, and one or two days of rest
at a lower elevation may be adequate for complete recovery. Once the
symptoms have fully resolved, cautious re-ascent is acceptable.
Summary of HAPE treatment
DESCENT, rest, oxygen, rehydration, and for severe cases, nifedipine,
salmeterol, acetazolamide, sildenafil or tadalafil and dexamethasone may
be used. Nifedipine, acetazolamide, sildenafil/tadalafil and
dexamethasone have all been shown to lower the pulmonary hypertensive
response to hypoxia, but they are prescription medicines for a good
reason -- they may be hazardous to use without appropriate medical
supervision and advice. Salmeterol is more commonly used as an asthma
medication, but it also can hasten the body's ability to re-absorb edema
fluid that clogs up the airways in HAPE. It is also a prescription
medication in most of the world.
HAPE can be confused with a number of other respiratory conditions:
High Altitude Cough and Bronchitis are both characterized by a
persistent cough with or without sputum production. There is no
shortness of breath at rest, no severe fatigue. Normal oxygen
saturations (for the altitude) will be measured if a pulse oximeter is
available.
Pneumonia can be difficult to distinguish from HAPE. Fever is common
with HAPE and does not prove the patient has pneumonia. Coughing up
green or yellow sputum may occur with HAPE, and both can cause low blood
levels of oxygen. The diagnostic test (and treatment) is descent - HAPE
will improve rapidly. If the patient does not improve with descent, then
consider antibiotics. HAPE is much more common at altitude than
pneumonia, and more dangerous; many climbers have died of HAPE when they
were mistakenly treated for pneumonia.
Asthma might also be confused with HAPE. Fortunately, asthmatics seem to
do better at altitude than at sea-level. If you think it's asthma, try
asthma medications, but if the person does not improve fairly quickly
assume it is HAPE and treat it accordingly..
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