Tuesday, 2 November 2010

MRCP revision battle 40.5: Acute mountain sickness, HAPE and HACE

Acute mountain sickness

Acute mountain sickness is usually a self-limiting condition.  

It tends to occur at altitudes higher than 2500m and develops gradually over 6 to 12 hours.

Symptoms are:
  • headache
  • nausea
  • fatigue

Ironically, fitter people are more at risk.

Risk can be decreased by gaining altitude at no more than 500m/day
Acetazolamide (a carbonic anhydrase inhibitor) can also help prevent.

The treatment is to descend.

HAPE = High Altitude Pulmonary oEdema

HAPE presents like pulmonary oedema.

Treatment is:
  • rapid descent
  • nifedipine
  • dexamethasone
  • acetazolamide
  • phosphodiesterase type V inhibitors (=tadalafil)

HACE = High Altitude Cerebral oEdema

This presents as headache, ataxia and papilloedema

Treatment is descent and dexamethasone.

Now for some trisomies....