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Altitude Sickness E902.0 T70.20

 

Altitude Sickness ICD-9

  • E902.0  Residence or prolonged visit at high altitude Residence or prolonged visit at high altitude as the cause of: Acosta syndrome Alpine sickness altitude sickness Andes disease anoxia, hypoxia barotitis, barodontalgia, barosinusitis, otitic barotrauma hypobarism, hypobaropathy mountain sickness range disease

Altitude Sickness ICD-10

  • G47.32 High altitude periodic breathing
  • T70.2 Other and unspecified effects of high altitude
  • T70.20 Unspecified effects of high altitude
  • T70.20XA Unspecified effects of high altitude, initial encounter
  • T70.20XD Unspecified effects of high altitude, subsequent encounter
  • T70.20XS Unspecified effects of high altitude, sequela
  • T70.29 Other effects of high altitude
  • T70.29XA Other effects of high altitude, initial encounter
  • T70.29XD Other effects of high altitude, subsequent encounter
  • T70.29XS Other effects of high altitude, sequela
  • W94.11 Exposure to residence or prolonged visit at high altitude
  • W94.11 XA Exposure to residence or prolonged visit at high altitude, initial encounter
  • W94.11 XD Exposure to residence or prolonged visit at high altitude, subsequent encounter
  • W94.11 XS Exposure to residence or prolonged visit at high altitude, sequela

 

Acute Mountain Sickness (AMS)

  • Determinates: rate of ascent, absolute altitude, time at altitude, level of exertion, sleeping altitude.
  • Heights: generally occurs above 8000 ft, but can occur at lower altitudes especially in patients with comorbidities.
  • Symptoms: similar to hangover, headache, fatigue, weakness, dizziness, lightheaded, anorexia, nausea, vomiting, insomnia, difficulty sleeping. Generally developing with 6-10 hours of recent arrival to unacclimated altitude.
  • Severe AMS may demonstrate: ataxia, extreme lassitude, irritability, confusion, impaired judgement, disorientation.
  • End Stage = High-Altitude Cerebral Edema (HACE)generally occurs 12-72 hours at heights >12,000ft. Ataxia and altered consciousness.
  • Prevention: slow ascent, 2-3nights at 8,000 ft before higher ascent, limit change in sleeping altitude to <2,000ft once above 8,000ft, avoid overexertion, no alcohol, adequate hydration, avoid carbon monoxide from cooking in tents etc, carbohydrate rich diet, Ginko biloba 80-120mg po bid
  • Treatment: stop ascent and descend 500m, acetazolamide 250mg PO BID or 500mg SR QD(speeds acclimization), NSAIDs(headache), Promethazine(nausea), low-flow oxygen, Prochloperazine(augments hypoxic response). If symptoms do not improve within 12hours or worsen descent is mandatory.

High-Altitude Cerebral Edema (HACE)

  • Generally occurs after 12-72hours at heights above 12,000 ft.
  • Symptoms: ataxia and/or altered consciousness, severe lassitude, severe headache, nausea, vomiting, cognitive dysfunction, hallucinations, stupor, coma. May have hemiplegia, hemiparesis, CN palsy, SZ or other focal deficits.
  • Physical Exam: hypoxia, retinal hemorrhages, pallor, cyanosis, focal neuro deficits.
  • Prevention: slow ascent, 2-3nights at 8,000 ft before higher ascent, limit change in sleeping altitude to <2,000ft once above 8,000ft, avoid overexertion, no alcohol, adequate hydration, avoid carbon monoxide from cooking in tents etc, carbohydrate rich diet, Ginko biloba 80-120mg po bid
  • Treatment: immediate descent. Consider acetazolamide 250mg PO BID or 500mg SR QD. Dexamethasone 8mg po/im/iv

High-Altitude Pulmonary Edema (HAPE)

  • Generally occurs 24-72 hours at heights above 10,000 ft.
  • Symptoms: dry cough, decreased activity tolerance, fatuge, dyspnea, weakness, may develop blood-tinged cough.
  • Physical exam: tachycardia, tachypnea, hypoxia, cyanosis(lips, nails), audible rales, fever.
  • Xray: CXR demonstrates pulmonary edema.
  • Prevention: slow ascent, 2-3nights at 8,000 ft before higher ascent, limit change in sleeping altitude to <2,000ft once above 8,000ft, avoid overexertion, no alcohol, adequate hydration, avoid carbon monoxide from cooking in tents etc, carbohydrate rich diet,
  • Teatment: high-flow oxygen, immediate descent. Consider acetazolamide 250mg PO BID or 500mg SR QD,

 

 

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