野外與登山醫學---content from uptodate 一般民眾應該知道的高海拔疾病 beyond the basic,

底下資料來自 uptodate. 它有兩個版本. 一個是 basics topic, 另一個是更進階的 beyond the basic, 這兩個都是提供給一般民眾的資訊. 這篇筆記僅列出 beyond the basic

一般民眾應該知道的關於高海拔疾病資訊
Patient education: High altitude illness (including mountain sickness) (Beyond the Basics)
Authors:Scott A Gallagher, MDPeter Hackett, MDSection Editor:Daniel F Danzl, MDDeputy Editor:Jonathan Grayzel, MD, FAAEM
Contributor Disclosures
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jun 2018. | This topic last updated: Mar 12, 2018.

高海拔疾病是因為低氧造成. 至高海拔旅行可能會加重某些已有的疾病.
INTRODUCTION — Ascending to or being at a new high altitude may cause high altitude illness (HAI). HAI includes acute mountain sickness (AMS), high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE). HAI is caused by lower oxygen levels in the air and thus the blood. Travel to high altitude may also exacerbate certain pre-existing medical conditions.

緩慢上升可避免高海拔疾病產生, 注意早期症狀徵象可避免高海拔疾病的併發症產生, 加速反應處理.
It is often possible to prevent HAI by ascending slowly and allowing your body to adjust as you go. Serious complications of high altitude disease can usually be avoided by watching for early signs and symptoms of high altitude illness and responding quickly.

危險因子, 要知道自己在高海拔是否會出現疾病是不可能的, 體力訓練無法避免高海拔疾病產生, 但某些情況可能增加風險.
1. 先前曾罹患過高海拔疾病
2. 在達成高度適應之前喝酒或運動.
3. 從低海拔快速上升至海拔 2400 公尺以上
4. 從海拔 2700 公尺以上, 快速上升每天超過 500-1000 公尺
5. 本身有疾病會影響呼吸
6. 在前幾周不曾到達過高海拔

RISK FACTORS — It is not possible to know in advance if you will become ill when traveling to a high altitude. In addition, being physically fit does not decrease your chances of developing a high altitude illness. However, certain groups are at increased risk, including people who:
●Have a prior history of high altitude illness
●Exercise or drink alcohol before adjusting to the change in altitude
●Ascend rapidly from low elevation to sleeping altitudes above 8000 feet (2400 m).
●Ascend rapidly (>500 to 1000 m /day in sleeping altitude), when over 9000 feet (2700 m).
●Have a medical problem that affects breathing
●Have not been to altitude in the previous few weeks




準備旅行- 如果你準備要睡在海拔 2400 公尺以上, 因為先前的經驗或其他危險因子, 擔心會發生高海拔疾病, 建議先找醫師. 討論旅行計畫, 當地醫療資源, 可能需要哪些藥物,
PREPARING TO TRAVEL — If you will be sleeping above 8000 feet (2400 m) and have concerns about developing altitude sickness because of prior episodes or other risk factors, you should make an appointment with a knowledgeable healthcare provider. During this visit, you should discuss your travel plans, availability of medical care at your destination, and the potential need for medicines to prevent and/or treat high altitude illness.

有慢性疾病的民眾
1. 糖尿病患者, 要小心血糖機在高海拔可能不準確, 請找廠商詢問
2. 心絞痛或曾罹患冠心症, 找自己的醫師諮詢
3. 氣喘在高海拔並不會增加危險, 但高海拔的冷空氣可能導致氣喘發作(是冷空氣, 不是高海拔)
4. 如果因肺部疾病需要使用氧氣, 在高海拔需要使用更高流量氧氣, 在平地不需要氧氣的病人, 高海拔可能需要氧氣(高海拔氧氣濃度下降). 找醫師諮詢
5. 鐮型貧血患者在海拔 2100 公尺以上可能需使用氧氣, 帶有鐮型貧血基因的人(有些可能自己不知道). 在海拔 2700 公尺以下也可能會發生高海拔相關的併發症(但罕見), 例如脾臟梗塞
6. 有肺部疾病, 例如 COPD. 囊性肺病, 肺炎, 肺高壓, 呼吸中止症. 找醫師諮詢
7. 高海拔可能影響血壓, 找醫師諮詢是否需藥物調整
8. 懷孕病患在海拔 2400 - 2700 公尺並不會增加風險, 如果已經出現懷孕併發症, 找醫師諮詢 (Acetazolamide is not recommended for pregnant women.)
Traveling with medical conditions — People with certain medical conditions need to take special precautions when traveling at high altitudes:
●If you have diabetes and you check your blood sugar, be aware that blood glucose meters can give inaccurate results at high altitudes. Consult the manufacturer of the meter for recommendations about high altitude readings.
●If you have angina or had a heart attack in the past, check with your doctor to be sure that it is safe to travel to high altitudes. If you develop chest pain, shortness of breath, or dizziness while traveling, seek medical help immediately.
●Asthma does not worsen at high altitudes, although cold-induced bronchospasm is a consideration in low temperature environments at high altitude.
●If you use oxygen because of lung disease, you will need a higher oxygen flow rate at high altitude. If you do not need oxygen for your lung disease at home, you might need oxygen at high altitude. Check with your doctor before you travel. (See "Patient education: Supplemental oxygen on commercial airlines (Beyond the Basics)".)
●If you have sickle cell disease, you will probably need oxygen if you travel above 7000 feet (2100 m). If you have sickle cell trait (some people do not know they do), altitude-related complications (eg, infarction of the spleen) can occur, even at altitudes below 9000 feet (2700 m), although this is rare.
●If you have lung disease, such as COPD, cystic fibrosis, pneumonia, pulmonary hypertension or sleep apnea, you should check with your doctor prior to travel to high altitude.
●If you have high blood pressure, be aware that traveling to high altitude could raise or sometimes lower your blood pressure; sometimes BP medication needs to be adjusted. Discuss with your doctor.
●If you are pregnant, traveling to sleeping altitudes of 8000 to 9000 feet is not risky for a normal pregnancy. If you have any complications of pregnancy, or if you are a smoker, discuss going to altitude with your doctor.

急性高山病 AMS.
最常見的高海拔疾病, 低海拔居民上升到高海拔 3000 公尺以上, 約 40-50 % 會出現AMS. 在海拔 2400 公尺以上發生率 25%. 某些人甚至在海拔 2000 公尺也會得到AMS.
ACUTE MOUNTAIN SICKNESS — Acute mountain sickness (AMS) is the most common of the altitude diseases; it occurs in approximately 40 to 50 percent of people who live at a low altitude and sleep at an altitude above 10,000 feet (3000 m), and in approximately 25 percent of those sleeping above 8000 feet (2400 m). Some people can develop AMS as low as 6500 feet (2000 m).

上升到海拔 2400 公尺以上, 症狀通常在 6-12 小時發生, 也可能在一小時至 24 小時內發生, 在同一海拔如果已經適應三天以上沒症狀, 不會再出現 AMS.
Symptoms usually occur within 6 to 12 hours of arrival at altitudes above 8000 feet (2400 m). Symptoms can begin as soon as one hour or as long as 24 hours after arriving. AMS does not occur after adjusting to a given altitude for three or more days.

預防 AMS.
緩慢上升是最佳方式, 將每天的海拔畫成圖.. 檢視每天上升高度是否會太快速, 根據下面建議調整.
1. 如果平常是生活在海拔 1500 公尺以下, 避免快速上升, 第一天睡眠海拔不要超過 2800 公尺
2. 如果預計要去海拔 3000 公尺以上地區旅遊, 每天睡眠的海拔不要增加超過 500 公尺, 每上升 1000 公尺海拔, 要安排一個休息日(無海拔上升), 休息日不要過度運動
3. 爬高睡低, 白天可以到較高海拔活動, 之後回到較低海拔睡覺. 這種方式有助於高度適應.
4. 如果計畫去滑雪, 爬山, 在高海拔前幾天不要做強度太大的運動, 避免飲酒或服用安眠藥, 尤其是在高度適應之前兩天.
5. 在出發前數週, 先到海拔 1500 公尺以上的地方停留或健行, 有助於高度適應(可以爬升快些)
6. 如果平常有引用咖啡的習慣, 不要突然停止飲用, 咖啡因在高海拔是安全的, 突然停止服用咖啡因可能導致類似AMS的症狀.

AMS prevention
Ascend slowly — Ascending slowly is the best way to avoid AMS. A good idea is to make a graph of planned days versus altitude to see where the ascent profile may be abrupt and then adjust it according to the recommendations below (figure 1). Some experts recommend the following:
●If you live below 5000 feet (1500 m), avoid ascending rapidly. On the first night, avoid sleeping above 9000 feet (2800 m).
●If you plan to travel above 9800 feet (3000 m), do not increase your sleeping altitude more than 1600 feet (500 m) per day as you go higher. Plan a day of rest for every 3300 feet (1000 m) you ascend. On this rest day, do not over-exert yourself.
●Climb high and sleep low. Hike to a higher altitude during the day and return to a lower elevation to sleep at night. This will help you adjust to the altitude.
●If you plan to ski, hike, or climb, do not over-exert yourself during the first few days at altitude. Pacing yourself is very important. Avoid alcohol and sleeping pills, especially as you are adjusting to the altitude in the first two days.
●Staying or hiking at elevations above 4900 feet (1500 m) in the weeks before you ascend may allow you to ascend faster.
●If you drink caffeine (coffee, tea, soda) regularly, do not stop drinking it before or during your trip. Caffeine is safe at high altitudes, and stopping it suddenly can cause symptoms similar to AMS.
These suggestions are particularly important if you have had AMS or another high altitude illness previously. (See "High altitude illness: Physiology, risk factors, and general prevention".)



考慮攜帶預防藥物- 如果先前不曾去過高海拔的地區, 或行程必須快速上升, 建議攜帶預防藥物
Consider taking a preventive medicine — Preventive treatment with a medicine may be recommended if you have had high altitude illness previously or if you must ascend quickly.

如果過去曾罹患高海拔疾病, 如果上升緩慢, 不一定需要服用預防性藥物.
If you have had high altitude illness before, you may be able to avoid taking preventive medicines by ascending slowly. You will need a prescription for these treatments.

通常會使用 acetazolamide=丹木斯, 在上升前一天開始服藥, 持續服藥 48 小時, 或直到抵達行程的最高海拔
●Prevention usually includes a medicine called acetazolamide, which you start taking the day before you ascend and continue for 48 hours or until you reach the highest point of your trip.

丹木斯 acetazolamide 會暫時性讓碳酸飲料飲用起來味道變奇怪 , 其他副作用包括會一直跑廁所(利尿)(丹木斯是一種利尿劑), 手腳麻木或刺痛, 噁心, 昏昏沉沉, 視覺模糊.
懷孕的人不建議使用丹木斯
Acetazolamide can temporarily cause carbonated drinks to taste unpleasant. Other side effects can include the need to urinate more frequently, numbness or tingling in the hands or feet, nausea, drowsiness, or blurry vision. Acetazolamide is not recommended for pregnant women.

** 上面中文是我自己翻譯的. 下面就直接用google翻譯了
乙醯唑胺是一種磺胺類藥物，但許多磺胺過敏的人可以毫無問題地服用乙醯唑胺。如果您對磺胺過敏，請諮詢您的醫生或護士，以確定​​您是否應該在旅行前服用測試劑量 [1]。(請參閱“未感染HIV患者的磺胺過敏”，關於‘交叉反應’一節)
●地塞米松是一種類固醇，如果您對乙醯唑胺過敏，可推薦將其作為預防性治療。
●服用阿斯匹靈或布洛芬有助於預防 AMS 經常出現的頭痛。如果您想快速上升，您可以在上升之前開始服用阿斯匹靈或布洛芬。否則，只有在出現頭痛時才服用。
AMS 症狀 — AMS 的症狀與宿醉類似，包括：
●頭痛
●感覺疲倦
●頭暈
●食慾不振
●難以入睡（頻繁醒來）
●噁心，有時伴隨嘔吐
這些症狀可能輕微或嚴重。AMS 症狀通常在第一個晚上後最嚴重，如果您不上升到更高的海拔，則在一天內就會改善。當您旅行到更高處時，症狀可能會再次出現。然而，即使您沒有爬得更高，症狀有時也會持續數天。
如果您出現 AMS 跡象，在症狀消失之前（通常在 24 小時內），您不應該繼續升高。在康復期間，您應該休息，避免飲酒和服用鎮靜劑或安眠藥。
這可能意味著您以及您的同伴將被延遲或無法到達您想要的高度或距離。然而，當您出現 AMS 症狀時，爬得更高可能會導致嚴重的併發症。
AMS 治療 — AMS 治療包括休息、下降，也可能包括緩解症狀的藥物。在症狀消失之前，您不應該運動或繼續更高的運動。您還應該知道何時以及是否需要尋求幫助。（請參閱下文「何時尋求協助」。）
●頭痛 – 您可以服用非處方藥治療頭痛，例如阿斯匹靈、對乙醯氨基酚（商品名：泰諾）或布洛芬（商品名稱範例：Advil、Motrin）。
●噁心或嘔吐－如果您出現噁心或嘔吐，如果有的話，昂丹司瓊（商品名：Zofran）等處方藥可能會有所幫助。
●下降 – 如果您的症狀在 24 至 48 小時內沒有改善或惡化，請下降到您感覺好轉的海拔高度。大多數人在下降 1600 至 3300 英尺（500 至 1000 公尺）後感覺會更好。
●氧氣－如果需要，透過罐子或濃縮器補充氧氣治療可以減輕AMS的症狀。只有當您出現症狀時或在睡覺時，您才可以使用氧氣一段時間（例如一小時），這特別有幫助。小型手持式氧氣罐只能提供幾次呼吸的氧氣，不太可能提供持續的緩解。大多數高海拔度假區都有家庭氧氣公司，您的醫生應該能夠提前開出氧氣處方。
●乙醯唑胺 – 乙醯唑胺是一種處方藥，可用於治療和預防 AMS。
●地塞米松 – 地塞米松是一種類固醇，可以減輕 AMS 的症狀。如果需要，您可以服用地塞米松和乙醯唑胺。地塞米松會增加糖尿病患者的血糖值。
何時尋求協助 — 隨著您適應海拔高度，AMS 症狀應該會有所改善，通常在 24 至 48 小時內。如果您的症狀在任何時候惡化，您應該下降或尋求幫助。
高原腦水腫 — 高原腦水腫 (HACE) 是一種罕見的危及生命的高原病，是急性高山症 (AMS) 的一種嚴重形式。它是由大腦中的毛細血管滲漏引起的，導致液體積聚和腦腫脹。
HACE 預防 — HACE 可以透過上述措施預防。(參見上文‘AMS的預防’)
HACE 症狀 — HACE 通常在海拔 9800 英尺（3000 公尺）以上旅行後一到三天內發生。症狀可能包括：
●嚴重精疲力盡或虛弱
●嗜睡、神智不清或煩躁
●難以直行
●採取醉酒
HACE 治療 — HACE 是一種醫療緊急情況，您應立即下降至較低海拔。等待下降可能是災難性的；症狀可能會迅速惡化，您可能無法行走。延遲下降會增加危及生命的併發症甚至死亡的風險。(參見「急性高山症和高山腦水腫」)
除了下降，其他 HACE 治療包括：
●補充氧氣－如果有的話，應該在下降過程中提供，或作為可以下降之前的臨時措施。您可以在高壓艙內使用氧氣。
●便攜式高壓艙－在可以下降之前，在便攜式高壓艙（有或沒有補充氧氣）中進行治療可以挽救生命。（請參閱下文『便攜式高壓艙』。）
●地塞米松—如果您打算在 9800 英尺（3000 公尺）以上的海拔高度睡覺，這是一種重要的藥物。若出現 HACE 症狀，應立即服用，建議劑量為口服 8 至 10 毫克。此後您應該每六小時服用 4 毫克，直到您下降。進入高壓艙之前，您應該服用地塞米松。
便攜式高壓艙 — 便攜式高壓艙是在偏遠地區使用的充氣壓力袋，可在無法立即下降時治療 HACE 患者。您被拉入腔室，並使用腳踏幫浦將設備充氣（圖 1）。
充氣後，室內的空氣更像是您在低海拔地區呼吸的空氣。這會增加血液中的含氧量，從而快速緩解高山症的症狀。您可以在密室中停留幾個小時。
高山肺水腫 — 高山肺水腫 (HAPE) 是一種潛在致命的疾病，其中肺毛細血管滲漏，液體積聚在肺部。HAPE 並不常見，但可能發生在快速上升到海拔 8200 英尺（2500 公尺）以上的人群中。
HAPE 預防 — 與其他高海拔疾病一樣，預防 HAPE 的最佳方法是緩慢上升。如果您以前有 HAPE 病史，則尤其如此。
通常不建議使用預防藥物，除非您有 HAPE 病史並且必須快速上升到 8200 英尺（2500 公尺）以上的海拔。預防藥物可能包括硝苯地平（常用於治療高血壓）、他達拉非、地塞米鬆或乙醯唑胺。(參見「高原肺水腫」)
HAPE 症狀 — HAPE 的症狀包括咳嗽（通常伴隨粉紅色泡沫痰）、休息或活動時呼吸困難以及上坡困難。這些症狀通常在到達海拔高度兩到四天後開始。您可能有也可能沒有急性高山症 (AMS) 症狀。（請參閱上文『AMS 症狀』。）
症狀可能會惡化，即使在休息時，您也可能會感到呼吸更加急促。您也可能開始咳出粉紅色、泡沫狀的痰（吐痰）。
HAPE 治療 — HAPE 是一種醫療緊急情況。如果出現症狀，您應該尋求醫療護理或盡快下山。等待下降可能是災難性的；症狀可能會迅速惡化，您可能無法行走。等待還會增加出現危及生命的併發症甚至死亡的風險。(參見「高原肺水腫」)
除了下降，其他HAPE治療包括：
●補充氧氣－這是最有效的治療方法，應盡快開始。應繼續治療直至症狀消失。如果無法下降，氧氣可能可以挽救生命。
●便攜式高壓艙－在可以下降之前，在便攜式高壓艙中進行治療可能是一種臨時措施。您可以在高壓艙內使用氧氣。(請參閱上文『攜帶式高壓艙』)
●如果無法獲得氧氣且無法下降，硝苯地平或其他藥物可能會有幫助。
●注意保暖，避免寒冷。
●休息；這包括下降時不攜帶背包。
從哪裡獲取更多資訊 — 您的醫療保健提供者是解答與您的醫療問題相關的問題和疑慮的最佳資訊來源。
本文將根據需要在我們的網站 (www.uptodate.com/ Patients) 上進行更新。還提供與患者相關的主題以及為醫療保健專業人員撰寫的精選文章。下面列出了一些最相關的內容。
病患層級資訊 — UpToDate 提供兩種類型的病患教育材料。
基礎知識 — 基礎知識病患教育部分回答了病患可能對特定病情提出的四到五個關鍵問題。這些文章最適合想要總體概述並喜歡簡短易讀材料的患者。
病患教育：高山症（包括高山症）（基礎篇）
超越基礎－超越基礎的病患教育文章更長、更複雜、更詳細。這些文章最適合想要深入資訊並熟悉一些醫學術語的患者。
Acetazolamide is a sulfa medicine, but many people with a sulfa allergy can take acetazolamide without a problem. If you are allergic to sulfa, talk to your doctor or nurse to determine if you should take a test dose before traveling [1]. (See "Sulfonamide allergy in HIV-uninfected patients", section on 'Cross-reactivity'.)
●Dexamethasone is a steroid that may be recommended as a preventive treatment if you are allergic to acetazolamide.
●Taking aspirin or ibuprofen can help to prevent the headache that often occurs with AMS. If you will be ascending quickly, you can start taking aspirin or ibuprofen before you ascend. Otherwise, take it only if you develop a headache.
AMS symptoms — The symptoms of AMS are similar to a hangover, and include:
●Headache
●Feeling tired
●Lightheadedness
●Lack of appetite
●Difficulty staying asleep (waking frequently)
●Nausea, sometimes with vomiting
These symptoms may be mild or severe. AMS symptoms are often the worst after the first night and improve within one day if you do not ascend to a higher altitude. Symptoms may return as you travel higher. However, symptoms can sometimes persist for days, even if you do not climb higher.
If you develop signs of AMS, you should NOT go higher until your symptoms have resolved (usually within 24 hours). You should rest and avoid drinking alcohol and taking sedatives or sleeping pills as you recover.
This may mean that you, as well as your fellow travelers, will be delayed or unable to go as high or as far as you had hoped. However, moving higher while you have symptoms of AMS can lead to serious complications.
AMS treatment — AMS treatment includes rest, descent, and may also include medicines to relieve symptoms. You should not exercise or proceed higher until your symptoms have resolved. You should also know when and if you need to seek help. (See 'When to seek help' below.)
●Headache – You can take non-prescription medicines for headache, such as aspirin, acetaminophen (brand name: Tylenol), or ibuprofen (sample brand names: Advil, Motrin).
●Nausea or vomiting – If you have nausea or vomiting, a prescription medicine such as ondansetron (brand name: Zofran) may be helpful, if it is available.
●Descent – If your symptoms do not improve or worsen over 24 to 48 hours, descend to an altitude where you feel better. Most people feel better after descending 1600 to 3300 feet (500 to 1000 m).
●Oxygen – If needed, treatment with supplemental oxygen via tank or concentrator can reduce the symptoms of AMS. You can use oxygen for a period of time (eg, one hour), only when you have symptoms, or while sleeping, which is especially helpful. Small handheld canisters of oxygen that provide only a few breaths of oxygen are unlikely to provide sustained relief. Home oxygen companies are present in most high-altitude resort areas and your doctor should be able to call in a prescription for oxygen in advance.
●Acetazolamide – Acetazolamide is a prescription medicine that you can take to treat and prevent AMS.
●Dexamethasone – Dexamethasone is a steroid that can reduce symptoms of AMS. You can take dexamethasone with acetazolamide, if needed. Dexamethasone increases blood sugar levels in people with diabetes.
When to seek help — AMS symptoms should improve as you adjust to the altitude, usually within 24 to 48 hours. If your symptoms worsen at any point, you should descend or seek help.
HIGH ALTITUDE CEREBRAL EDEMA — High altitude cerebral edema (HACE) is a rare life-threatening altitude disease, and is a severe form of acute mountain sickness (AMS). It is caused by leaky capillaries in the brain, which causes fluid accumulation and brain swelling.
HACE prevention — HACE can be prevented with the measures discussed above. (See 'AMS prevention' above.)
HACE symptoms — HACE usually occurs within one to three days after traveling above 9800 feet (3000 m). Symptoms may include:
●Severe exhaustion or weakness
●Drowsiness, confusion or irritability
●Difficulty walking straight
●Acting drunk
HACE treatment — HACE is a medical emergency and you should immediately descend to a lower altitude. Waiting to descend can be disastrous; symptoms can worsen quickly and you may not be able to walk. Delaying descent increases the risk of life-threatening complications, or even death. (See "Acute mountain sickness and high altitude cerebral edema".)
Besides descent, other HACE treatments include:
●Supplemental oxygen – If available, should be provided during descent or as a temporizing measure until descent is possible. You can use oxygen inside a hyperbaric chamber.
●Portable hyperbaric chamber – Treatment in a portable hyperbaric chamber (with or without supplemental oxygen) can be life-saving until descent is possible. (See 'Portable hyperbaric chamber' below.)
●Dexamethasone – This is an important medicine to have on hand if you plan to sleep above 9800 feet (3000 m). You should take it immediately if you develop signs of HACE, with the recommended dose being 8 to 10 mg by mouth. You should take 4 mg every six hours thereafter until you have descended. You should take dexamethasone before entering a hyperbaric chamber.
Portable hyperbaric chamber — Portable hyperbaric chambers are inflatable pressure bags used in remote settings that can treat people with HACE when immediate descent is not feasible. You are zipped into the chamber and the device is inflated with a foot pump (picture 1).
When inflated, the air inside the chamber is more like the air you breathe at lower altitudes. This increases the amount of oxygen in your blood, relieving symptoms of high altitude illness quickly. You can remain in the chamber for several hours.
HIGH ALTITUDE PULMONARY EDEMA — High altitude pulmonary edema (HAPE) is a potentially fatal condition in which lung capillaries leak and fluid accumulates in the lungs. HAPE is uncommon, but can occur in people who rapidly ascend to altitudes above 8200 feet (2500 m).
HAPE prevention — As with other high altitude illnesses, the best way to prevent HAPE is to ascend slowly. This is especially true if you have a previous history of HAPE.
Preventive medicines are not usually recommended unless you have a history of HAPE and you must ascend quickly to altitudes above 8200 feet (2500 m). Preventive medicines may include nifedipine (commonly used to treat high blood pressure), tadalafil, dexamethasone, or acetazolamide. (See "High altitude pulmonary edema".)
HAPE symptoms — Symptoms of HAPE include cough (often with pink, frothy sputum), breathlessness at rest or with activity, and difficulty walking uphill. These symptoms usually begin two to four days after arriving at altitude. You may or may not also have symptoms of acute mountain sickness (AMS). (See 'AMS symptoms' above.)
Symptoms can worsen, and you may feel more short of breath, even while resting. You may also begin to cough up pink, frothy sputum (spit).
HAPE treatment — HAPE is a medical emergency. You should seek medical care or descend as soon as possible if you develop symptoms. Waiting to descend can be disastrous; symptoms can worsen quickly and you may not be able to walk. Waiting also increases the risk of developing life-threatening complications, or even death. (See "High altitude pulmonary edema".)
Besides descent, other HAPE treatments include:
●Supplemental oxygen – This is the most effective treatment and should be started as soon as possible. It should be continued until symptoms resolve. Oxygen may be life-saving if descent is not possible.
●Portable hyperbaric chamber – Treatment in a portable hyperbaric chamber may be a temporizing measure until descent is possible. You can use oxygen inside a hyperbaric chamber. (See 'Portable hyperbaric chamber' above.)
●Nifedipine or other medicines may be helpful if oxygen is not available and descent is not possible.
●Stay warm and avoid cold temperatures.
●Rest; this includes not carrying a pack while descending.
WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Altitude sickness (including mountain sickness) (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Supplemental oxygen on commercial airlines (Beyond the Basics