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Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Nifedipine for High Altitude Pulmonary Edema

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In the Spring 2012 issue of the journal Wilderness & Environmental Medicine appears an article by Rajesh Deshwal and colleagues entitled “Nifedipine for the Treatment of High Altitude Pulmonary Edema” (WEM 23, 7-10, 2012). It is an interesting study with the purpose to assess the risk factors, patient profile, clinical features, and oral nifedipine as a treatment option for certain patients with high altitude pulmonary edema. The study was performed in a military hospital in India.

Over a 3-year period, 110 patients suffering from high altitude pulmonary edema (HAPE) were treated. The risk factors for developing HAPE were not unique relative to what has been previously noted: improper acclimatization, faster rates of ascent, higher height for the first stage of acclimatization, exposure to cold, intense exercise, and respiratory infection. All patients were treated by bringing them to lower altitude, providing supplemental oxygen (using nasal prongs), and bed rest. In addition, the patients were either given oral nifedipine or a placebo (no active drug). The patients were then evaluated for normalization of oxygen saturation in the blood, duration of hospital stay, time needed for resolution of abnormal lung sounds on physical examination, and clearance of abnormal findings on chest x-ray.

In this study, nifedipine offered no additional benefit when added to the other therapies. How best to interpret this finding? Perhaps by the time that nifedipine was added to the other therapies, the ultimate outcome was already locked in. However, it could not be determined from this study whether in the absence of being able to combine all the other therapies along with nifedipine, the drug would have made a difference. So, it still might be useful when used alone to treat HAPE or when one or more of the other field treatments (notably oxygen therapy or descent) is not available.

 

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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