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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute mountain sickness (A.M.S.) and its severe complications, high-altitude pulmonary oedema (H.A.P.O.) and cerebral oedema (C.O.), were studied in 278 unacclimatised hikers at 4243 m altitude at Pheriche in the Himalayas of Nepal. The overall incidence of A.M.S. was 53%, the incidence being increased in the young and in those who flew to 2800 m, climbed fast, and spent fewer nights acclimatising en route. It was unrelated to sex, to previous altitude experience, to the load carried, and to recent respiratory infections. The severity of A.M.S. was inversely related to age (independent of rate of ascent) and the highest altitude attained, and was highly ocrrelated with speed of ascent. There were 7 cases of H.A.P.O. and 5 with the more intractable C.O. and, of these 12, 11 had flown in, 9 had spent only one night at Pheriche, and none were on acetazolamide. 11 required evacuation. Acetazolamide, compared in a double-blind study with a placebo and also compared with no tablets at all, reduced both the incidence and the severity of A.M.S. in those who flew to 2800 m but not in those who hiked up to that altitude. Prevention consists in slow ascent, rapid recognition of warning signs, and prompt descent to avoid progression.
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PMID:The incidence, importance, and prophylaxis of acute mountain sickness. 6 91

Increased travel to high altitude areas by mountaineers and nonclimbing tourists has emphasized the clinical problems associated with rapid ascent. Acute mountain sickness affects most sojourners at elevations above 10,000 feet. Symptoms are usually worse on the second or third day after arrival. Gradual ascent, spending one to three days at an intermediate altitude, and the use of acetazolamide (Diamox) will prevent or ameliorate symptoms in most instances. Serious and potentially fatal problems, such as high altitude pulmonary edema or cerebral edema, occur in approximately 0.5 percent to 1.0 percent of visitors to elevations above 10,000 feet-especially with heavy physical exertion on arrival, such as climbing or skiing. Early recognition, high flow oxygen therapy and prompt descent are crucially important in management. Our knowledge of the causes of these and other high altitude problems, such as retinal hemorrhage, systemic edema and pulmonary hypertension, is still incomplete. Even less is known of the effect of high altitudes on medical conditions common at sea level or on the action of commonly used drugs.
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PMID:High altitude medical problems. 48 5

Acetazolamide is a useful prophylactic for acute mountain sickness causing marked reduction in headache, nausea, vomiting, weakness, etc. Improvements correlate with increased arterial oxygen concentrations, reduction in proteinuria and peripheral oedema and other objective measures of acute mountain sickness. Evidence that Acetazolamide is beneficial for pulmonary oedema or cerebral oedema is scanty because of the lower frequency of these severe forms of mountain sickness. Dexamethasone, used prophylactically, also reduces the symptoms of acute mountain sickness partly due to its euphoric effect. Use of Acetazolamide as a treatment for established acute mountain sickness has been investigated. Large doses of Acetazolamide increase arterial oxygen levels over a few hours and this leads to a reduction of symptoms but data is limited and faster acting carbonic anhydrides inhibitors such as Methazolamide may be preferable in an emergency situation. There is no comparison of the effectiveness of Acetazolamide with other drugs used for treating acute mountain sickness such as steroids and calcium channel blocking drugs. Also, there is no data on drug combinations which could have additive effects and thereby be more beneficial than individual drugs.
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PMID:Acetazolamide and high altitude diseases. 148 96

Acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema are illnesses associated with acute exposure to altitudes greater than 8000 ft. Although usually self-limiting problems, they can be severe and life threatening. Gradual ascent to allow acclimatization can lessen or prevent symptoms. Acetazolamide is the drug of choice for pharmacologic prophylaxis; descent to lower elevation is the definitive treatment for altitude illness. Individuals who have chronic cardiac, respiratory, or certain other medical conditions may require supplemental oxygen and should be aware of restrictions regarding high-altitude exposure.
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PMID:High-altitude illness. 155 67

People who ascend rapidly to altitudes greater than 3,000 meters (10,000 ft) may become ill; rarely, some may die from an inability to adapt to hypoxia. Age, pre-existing cardiopulmonary or hematologic disease, and the rate and degree of ascent are known to limit man's adaptation to high altitudes. Other factors, such as blunted hypoxic respiratory drive and sublinical disease of the pulmonary vascular bed are probably also important. Pre-exposure with acetozolamide (Diamox) helps, but once symptoms of high altitude pulmonary edema (HAPE) occur, supplemental oxygen and rapid descent to lower altitudes are the only known remedies. In view of the steady increase in the number of people who work and play at high altitudes, physicians must understand the pathophysiologic mechanisms involved in order to treat properly and to counsel patients.
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PMID:Medical consequences of acute exposure to high altitude. 206 Oct 35

Acute mountain sickness (AMS) and high-altitude pulmonary edema (HAPE) continue to cause significant morbidity and occasional deaths among mountain recreationists and residents. Descent to lower altitude is still considered the treatment of choice, but an increased role for medical therapy is emerging. Acetazolamide is currently the drug of choice for prevention of AMS, and probably HAPE as well. Numerous studies have demonstrated the drug's effectiveness when it is started 12 to 24 hours before ascent. Suggestions for indications, dosage, and regimen vary with different authors. Lower dosage offers adequate protection with fewer side effects. Acetazolamide has still not been adequately studied for treatment of altitude illness. Oxygen effectively treats HAPE and mild AMS, but is not as useful for cerebral edema. Dexamethasone recently was found effective for treatment of AMS, including early cerebral edema, but not for advanced cerebral edema. Side effects limit its use for prophylaxis, but dexamethasone offers an alternative to acetazolamide for those with sulfa intolerance.
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PMID:Medical therapy of altitude illness. 330 58

The role of CO2 in hyperbaric oxygen toxicity was investigated by administering acetazolamide (Diamox), Tris buffer [tris(hydroxymethyl)aminomethane], and sodium bicarbonate by i.p. injection, and by exposure of other groups of animals to an atmosphere of 5% CO2 and 95% O2. All animals were placed in a pressure chamber and maintained at 50 psig in 100% O2 until death. The Tris buffer and the sodium bicarbonate buffer significantly extended time to onset of convulsions and to time of death. Acetazolamide and also 5% CO2 shortened time to onset of convulsions and significantly shortened survival time. These results suggest that increased tissue levels of CO2 play an important role in hyperbaric oxygen toxicity. The cause of death in our animals exposed to hyperbaric oxygen was pulmonary edema secondary to a systemic hypertension.
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PMID:Acetazolamide and CO2 in hyperbaric oxygen toxicity. 680 59

Climbing in the Alps and trekking in the Andes or in the Himalayas became more and more popular in the last years. This is the reason why more and more tourists develop symptoms of acute mountain sickness (AMS) at an altitude higher than 2500 m a.s.l. To avoid an unpleasant stay at altitude, an accurate acclimatization is necessary. This can be achieved by a slow ascent at a climbing rate of 300 to 600 m in one day. If that is not possible, climbers should spend at least nine or more nights at an altitude higher than 2500 m a.s.l. in the last 30 days before ascent. This would improve performance at high altitude and significantly decrease symptoms of AMS. If acclimatization for one or another reason may not be possible or if somebody is still susceptible to AMS, pharmacological prophylaxis and treatment can be used. Drug of first choice for AMS prophylaxis is acetazolamide, a carboanhydrase inhibitor who increases ventilation. Acetazolamide has been used in a dosage of 250 to 500 mg 12 to 24 h. before ascent. If climbers have a history of high-altitude pulmonary edema (HAPE), nifedipine, a potent vasodilator which decreases pulmonary artery pressure, is the drug of the first choice and should be taken in a dosage of 3 x 20 mg, beginning one day before climbing and continuing during climbing. Prophylactic administration of nifedipine has no effect on symptoms of AMS in subjects who are not susceptible to HAPE.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prevention and therapy of altitude sickness]. 837 72

Acute mountain sickness (AMS) affects, to varying degrees, all travelers to high altitudes (elevations greater than 5280 feet). In a small percentage of patients, AMS can lead to high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE). Symptoms of AMS range from a combination of headache, insomnia, anorexia, nausea, and dizziness, to more serious manifestations, such as vomiting, dyspnea, muscle weakness, oliguria, peripheral edema, and retinal hemorrhage. Although the primary cause of these symptoms is related to the reduced oxygen content and humidity of the ambient air at high altitudes, the physiologic pathway relating hypoxemia to AMS and its sequelae remains unclear. Tips on self-diagnosis and symptom recognition are critical elements to be included in educating patients who are contemplating a trip to high altitudes. Preventive strategies include allowing 2 days of acclimatization before engaging in strenuous exercise at high altitudes, avoiding alcohol, and increasing fluid intake. Conditioning exercise for patients older than 35 years is also recommended before departure. A high-carbohydrate, low-fat, low-salt diet can also aid in preventing the onset of AMS. Acetazolamide (125 mg two or three times daily, or once at bedtime) has also been shown to reduce susceptibility to AMS and the incidence of HAPE and HACE. Although effective in treating cerebral symptoms of AMS, dexamethasone is not routinely recommended as a prophylactic agent for AMS.
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PMID:A trek to the top: a review of acute mountain sickness. 855 56

A woman aged 66 was prescribed acetazolamide (Diamox) in the outpatient clinic because of glaucoma. She went into irreversible anaphylactic shock with massive pulmonary oedema, probably due to a cross reaction in sulphonamide allergy. Before prescribing acetazolamide, the physician should inquire about sulphonamide allergy because of the related chemical structure of the substances. Such an allergy should be regarded as a contraindication.
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PMID:[Fatal anaphylactic reaction after oral acetazolamide (diamox) for glaucoma]. 1108 98


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