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

  1. Altered mental status, ataxia, gait disturbance, stupor (most sensitive findings)
    1. Progresses to coma if untreated
  2. Headache, nausea, and vomiting are not always present
  3. Focal neuro deficits may be seen (3rd/6th CN palsies)
  4. Seizures are rare

Differential Diagnosis

High Altitude Illnesses

Treatment

  1. Immediate descent is the treatment of choice
  2. If descent not possible use combination of:
    1. Supplemental O2 (goal SpO2 90%)
    2. Dexamethasone 8mg initially, then 4mg q6hr
    3. Acetazolamide 250 mg BID (better as ppx)
    4. Hyperbaric bag if available

Prevention

  • Acetazolamide 125mg BID (250mg BID if greater than 100kg)
  • Dexamethasone 2mg q6h OR 4mg q12h

See Also

High Altitude Medicine

Source

  • Tintinalli
  • Cone David, et al. Emergency Medical Services: Clinical Practice and Systems Oversight, 2 Volume Set. John Wiley & Sons, Dec 30, 2014.