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Altitude Illness
Diagnosis of Altitude Illness
Clinical evaluation Prompt diagnosis and initiation of treatment of high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE) are essential to prevent coma and death. Diagnosis of altitude illness is usually clinical; laboratory tests are usually unnecessary and may be unavailable depending on the setting in which illness develops (eg, remote mountain valley versus mountain resort community). However, imaging, when available, may be useful for HAPE and sometimes HACE. In HAPE, hypoxemia is often severe, with pulse oximetry showing 40 to 70% saturation, depending on the elevation at which the individual becomes ill. Plain chest radiography shows a normal-sized heart and patchy lung edema. HACE can usually be differentiated from other causes of headache and coma (eg, infection, brain hemorrhage, uncontrolled diabetes) by history and clinical findings; if not, CT or MRI imaging of the head may help rule out other causes. MRI findings in HACE, such as microhemorrhages, can persist for many months after illness and thus help confirm HACE after a return from a trip to high altitude. The Lake Louise acute mountain sickness score is a tool that can be used in diagnosis of AMS but is primarily designed for the purpose of research studies rather than clinical practice ( Diagnosis reference ). 1.Roach RC, Hackett PH, Oelz O, et al: The 2018 Lake Louise acute mountain sickness score.High Alt Med Biol19(1):4-6, 2018. doi: 10.1089/ham.2017.0164 