Management of high altitude pulmonary edema in the Himalaya: a review of 56 cases presenting at Pheriche medical aid post (4240 m)

Wilderness Environ Med. 2013 Mar;24(1):32-6. doi: 10.1016/j.wem.2012.07.004. Epub 2012 Oct 10.


Objective: The purpose of this study was to review the patient characteristics and management of 56 cases of high altitude pulmonary edema at the Pheriche Himalayan Rescue Association Medical Aid Post, and to measure the use of medications in addition to descent and oxygen.

Methods: In a retrospective case series, we reviewed all patients diagnosed clinically with high altitude pulmonary edema during the 2010 Spring and Fall seasons. Nationality, altitude at onset of symptoms, physical examination findings, therapies administered, and evacuation methods were evaluated.

Results: Of all patients, 23% were Nepalese, with no difference in clinical features compared with non-Nepalese patients; 28% of all patients were also suspected of having high altitude cerebral edema. Symptoms developed in 91% of all patients at an altitude higher than the aid post (median altitude of onset of 4834 m); 83% received oxygen therapy, and 87% received nifedipine, 44% sildenafil, 32% dexamethasone, and 39% acetazolamide. Patients who were administered sildenafil, dexamethasone, or acetazolamide had presented with significantly lower initial oxygen saturations (P ≤ .05). After treatment, 93% of all patients descended; 38% descended on foot without a supply of oxygen.

Conclusions: A significant number of patients presenting to the Pheriche medical aid post with high altitude pulmonary edema were given dexamethasone, sildenafil, or acetazolamide in addition to oxygen, nifedipine, and descent. This finding may be related to perceived severity of illness and evacuation limitations. Although no adverse effects were observed, the use of multiple medications is not supported by current evidence and should not be widely adopted without further study.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acetazolamide / therapeutic use
  • Altitude Sickness / ethnology
  • Altitude Sickness / therapy*
  • Dexamethasone / therapeutic use
  • Emergency Treatment / methods
  • Female
  • Humans
  • Hypertension, Pulmonary / ethnology
  • Hypertension, Pulmonary / therapy*
  • Male
  • Mountaineering
  • Nepal
  • Nifedipine / therapeutic use
  • Oxygen Inhalation Therapy*
  • Piperazines / therapeutic use
  • Purines / therapeutic use
  • Retrospective Studies
  • Seasons
  • Sildenafil Citrate
  • Sulfones / therapeutic use
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use*


  • Piperazines
  • Purines
  • Sulfones
  • Vasodilator Agents
  • Dexamethasone
  • Sildenafil Citrate
  • Nifedipine
  • Acetazolamide

Supplementary concepts

  • Pulmonary edema of mountaineers