High altitude cerebral edema: Difference between revisions
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#Immediate descent is the treatment of choice | #Immediate descent is the treatment of choice | ||
#If descent not possible use combination of: | #If descent not possible use combination of: | ||
##Supplemental O2 | ##Supplemental O2 (goal SpO2 90%) | ||
##Dexamethasone 8mg initially, then 4mg q6hr | ##Dexamethasone 8mg initially, then 4mg q6hr | ||
##Acetazolamide 250 mg BID (better as ppx) | ##Acetazolamide 250 mg BID (better as ppx) | ||
Revision as of 00:07, 2 March 2015
Background
- Also known as HACE
- Progressive neurologic deterioration in someone with AMS or HAPE (due to incr ICP)
- Almost never occurs at <8000ft
Clinical Features
- Altered mental status, ataxia, gait disturbance, stupor (most sensitive findings)
- Progresses to coma if untreated
- Headache, nausea, and vomiting are not always present
- Focal neuro deficits may be seen (3rd/6th CN palsies)
- Seizures are rare
Differential Diagnosis
High Altitude Illnesses
- Acute mountain sickness
- Chronic mountain sickness
- High altitude cerebral edema
- High altitude pulmonary edema
- High altitude peripheral edema
- High altitude retinopathy
- High altitude pharyngitis and bronchitis
- Ultraviolet keratitis
- Dehydration
- Exhaustion
- Hypoglycemia
- Hypothermia
- Hyponatremia
Treatment
- Immediate descent is the treatment of choice
- If descent not possible use combination of:
- Supplemental O2 (goal SpO2 90%)
- Dexamethasone 8mg initially, then 4mg q6hr
- Acetazolamide 250 mg BID (better as ppx)
- Hyperbaric bag if available
See Also
Source
Tintinalli