You are on page 1of 17

MAL DE ALTURA

MANUEL CHACON LECOURT PROGRAMA DE MEDICINA DE URGENCIA
N Engl J Med, Vol. 345, No. 2 · July 12, 2001 www.nejm.org

.

MAL DE ALTURA ‡ Síntomas producidos por el ascenso a alturas superiores a 2.500 m sobre el nivel del mar en personas no aclimatadas. .800 – 3.

000 22% 42% .850 – 2. ≥3.EPIDEMIOLOGIA ‡ Altura 1.750 mt.

A.) ‡ Ejercicio ‡ Enfermedades Cardiopulmonares previas ‡ Menores de 50 años ‡ ♂ > riesgo Edema Pulmonar que ♀ ‡ .FACTORES DE RIESGO Historia previa de Mal de la Altura (M.

nauseas. Mal de Montaña agudo: cefalea en una persona no aclimatada. que pueden ser leves o llegar hasta edema cerebral. vómitos insomnio.CLÍNICA DEL MAL DE ALTURA ‡ ‡ El Mal de Altura (M.) > 2. – 6 hrs.) es un síndrome de síntomas inespecíficos. vértigo. A. que ha subido recientemente (1 hrs.500 mts más 1 o más de: „ „ Gastrointestinales: SNC : anorexia. lasitud o fatiga ‡ No hay signos físicos diagnósticos .

EDEMA CEREBRAL ‡ ‡ ‡ ‡ Es el último paso del Mal de Montaña aguda. parálisis de nervios craneales. Son raras las convulsiones. hemorragia retinal. Es un diagnóstico clínico: ataxia y alteración de conciencia o ambos. La causa de muerte es la herniación cerebral . en un paciente con mal de altura o edema pulmonar de altura Hallazgos asociados: edema papilar.

Ocurre comúnmente.EDEMA PULMONAR ‡ ‡ ‡ ‡ ‡ Produce la mayoría de las muertes por M. A. 14% se asocia a edema cerebral . crepitaciones (axilar derecha) 50% se asocia a síntomas M. Clínica: Tos seca Taquicardia y taquipnea de reposo Tardíos: distress respiratorio y desgarro sanguinolento Fiebre (38°). la segunda noche a nueva altitud y no más allá del 4° día. A.

EDEMA PULMONAR .

FISIOPATOLOGÍA .

or alcohol Migraine Seizures Stroke Transient ischemic attack Viral or bacterial infection TABLE 1-A DIFFERENTIAL DIAGNOSIS OF HIGH-ALTITUDEILLNESSES. . drugs.DIAGNOSTICO DIFERENCIAL Acute mountain sickness and high-altitude cerebral edema Acute psychosis Arteriovenous malformation Brain tumor Carbon monoxide poisoning Central nervous system infection Dehydration Diabetic ketoacidosis Exhaustion Hangover Hypoglycemia Hyponatremia Hypothermia Ingestion of toxins.

Hyperventilation syndrome Mucus plugging Myocardial infarction Pneumonia Pulmonary embolus .DIAGNOSTICO DIFERENCIAL High-altitude pulmonary edema Asthma Bronchitis TABLE 1-B Heart failure DIFFERENTIAL DIAGNOSIS OF HIGH-ALTITUDEILLNESSES.

avoid direct transport to an altitude of more than 2750 m. avoid overexertion. consider taking acetazolamide (125 to 250 mg twice daily) beginning 1 day before ascent and continuing for 2 days at high altitude ‡ Mild acute mountain sickness Headache with nausea. spend a night at an intermediate altitude. dizziness. or stop. rest. and fatigue during first 12 hr after rapid ascent to high altitude (>2500 m) . or treat symptoms with analgesics and antiemetics. PREVENTION Ascend at a slow rate. or use a combination of these approaches. or speed acclimatization with acetazolamide (125 to 250 mg twice daily). and acclimatize.TRATAMIENTO CLINICAL PRESENTATION ‡ MANAGEMENT Descend 500 m or more.

dexamethasone (4 mg orally or intramuscularly every 6 hr). or both until symptoms resolve. insomnia. avoid direct transport to an altitude of more than 2750 m. fluid retention at high altitude for 12 hr or more .TRATAMIENTO CLINICAL PRESENTATION ‡ MANAGEMENT Descend 500 m or more. ‡ Moderate acute mountain sickness Moderate-tosevere headache with marked nausea. PREVENTION Ascend at a slow rate. use a portable hyperbaric chamber or administer low-flow oxygen (1 to 2 liters/min). lassitude. if descent is not possible. if descent is not possible and oxygen is not available. administer acetazolamide (250 mg twice daily). dizziness. consider taking acetazolamide (125 to 250 mg twice daily) beginning 1 day before ascent and continuing for 2 days at high altitude. treat symptoms. treat acute mountain sickness early. avoid overexertion. or use a combination of these approaches. spend a night at an intermediate altitude.

Portable Hyperbaric Bag .

administer dexamethasone (8 mg orally. ataxia . ascend at a slow rate. use a portable hyperbaric chamber. avoid overexertion.TRATAMIENTO CLINICAL PRESENTATION ‡ ‡ MANAGEMENT Initiate immediate descent or evacuation. and then 4 mg every 6 hr). PREVENTION Avoid direct transport to an altitude of more than 2750 m. administer oxygen (2 to 4 liters/min). treat acute mountain sickness early High-altitude cerebral edema Acute mountain sickness for 24 hr or more. administer acetazolamide if descent is delayed. or intravenously initially. consider taking acetazolamide (125 to 250 mg twice daily) beginning 1 day before ascent and continuing for 2 days at high altitude. severe lassitude. if descent is not possible. intramuscularly. mental confusion.

drowsiness. or use a portable hyperbaric chamber. rest. PREVENTION Administer oxygen (4 to 6 liters/min until condition improves.TRATAMIENTO CLINICAL PRESENTATION ‡ MANAGEMENT Descend 500 m or more. if descent is not possible or oxygen is not available. or treat symptoms with analgesics and antiemetics. descend as soon as possible. moist cough. and acclimatize. add dexamethasone if neurologic deterioration occurs. rales ‡ . tachypnea. administer nifedipine (10 mg orally initially and then 30 mg of extendedrelease formulation orally every 12 to 24 hr). High-altitude pulmonary edema Dyspnea at rest. and then 2 to 4 liters/min to conserve supplies). tachycardia. or use a combination of these approaches. cyanosis. with minimal exertion. or speed acclimatization with acetazolamide (125 to 250 mg twice daily). severe weakness. or stop.