Yesterday and today ... 2004 flashback re: HAPE
May 5, 2007 10: 06 EST
Just about 3 years ago our clinic had the good fortune of meeting Joe Hughes. He was just another climber intent on the summit, but our lives and relationship quickly changed when he developed a near fatal case of HAPE while up on the mountain. His team assisted him down to our clinic, where we spent a rocky 16 hours together. Happily, Joe went on to recover and a few months after he returned home he and his wife Liz welcomed the birth of their first child. She's 2 1/2 years old now, and continues to support our clinic (notice the patch she's wearing?) We love our little clinic mascot!
As climbers rest and plan their summit attempts, we prepare to counsel and treat them for serious altitude illness high on the mountain. Joe's story, unfortunately, is not unusual at extreme altitudes.
HAPE 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 development of fluid in the lungs.
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 folks who develop HAPE, 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.
Safe and happy climbing to all of our EBC camp friends!
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