High altitude cerebral edema: Difference between revisions
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##Acetazolamide 250 mg BID (better as ppx) | ##Acetazolamide 250 mg BID (better as ppx) | ||
##Hyperbaric bag if available | ##Hyperbaric bag if available | ||
==Prevention== | |||
*Acetazolamide 125mg BID (250mg BID if greater than 100kg) | |||
*Dexamethasone 2mg q6h OR 4mg q12h | |||
==See Also== | ==See Also== |
Revision as of 08:56, 18 September 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
Prevention
- Acetazolamide 125mg BID (250mg BID if greater than 100kg)
- Dexamethasone 2mg q6h OR 4mg q12h
See Also
Source
- Tintinalli
- Cone David, et al. Emergency Medical Services: Clinical Practice and Systems Oversight, 2 Volume Set. John Wiley & Sons, Dec 30, 2014.