High altitude pulmonary edema

Abstract

High altitude pulmonary edema is the consequence of an acute loss of acclimatization in people who, having lived in the mountains, make a trip to sea level, only to return to high altitude after days or weeks.
 
It can occur in people who are going to the height for the first time or who, being from the mountains, make ascents.
 
The symptoms can appear early or after days and even weeks or months and can present in a sub-acute, acute, fulminant form or with cerebral or urinary manifestations.
 
There seems to be a personal as well as a family predisposition.
 
In the pathogenesis, a background of pulmonary hypertension caused by hypoxia and triggered by alterations in cardiocirculatory and pulmonary hemodynamics must essentially be recognized.
 
The producing factors and mechanisms are not perfectly known.
 
In autopsy data, pulmonary edema, ischemic lesions in the brain, liver and kidneys and in the adrenal glands the trace of stress have been verified.
 
The main symptoms are: cough, diarrhea, mental disorders, bronchoalveolar rales in both lung fields, cyanosis, which added to the history of transfer to different altitude levels facilitate the diagnosis.
 
The flat radiograph allows to appreciate a mottling of the middle and upper thirds of the lung fields, especially the right.
 
The electrocardiographic tracing corresponds to an acute pulmonary heart.
 
In terms of differential diagnosis, bronchopneumonia, acute pulmonary edema due to congestive heart failure, spontaneous neuthorax bronchial asthma and occasionally diaphragmatic hernia should be taken into account. As treatment should be indicated essentially rest and oxygen, being very useful morphine and digoxin.
 
In maintenance, diuretics and antibiotics can be added.
 
If considered useful, some research could be attempted on the effects that altitude and oxygen desaturation have on our population, also being able to focus attention on that very widespread condition among us and that is known as soroche and that seems closely linked to oxygen deficit problems at high altitudes.
 
It should be considered that altitude sickness is an existing entity in our environment and that in the future its diagnosis and recognition will be more frequent.