Robert L. Cosby, MD; Aris M. Sophocles, MD; Jacques A. Durr, MD; Craig L. Perrinjaquet, MD; Berne Yee, MD; Robert W. Schrier, MD
A diagnosis of acute high-altitude pulmonary edema was made in five male skiers (age, 35.0 ± 1.8 years) by history and physical examination and was confirmed by a characteristic chest radiogram showing alveolar infiltrates associated with a normal cardiac silhouette. Five healthy age- and sex-matched subjects with similar physical activity at the same altitude served as controls. Plasma sodium was 135.0 ± 1.5 mmol/L in the acutely ill patients compared with 144.0 ± 3.3 mmol/L in the controls (P < 0.025). Mean plasma atrial natriuretic factor immunoreactivity averaged 17.6 ± 5.6 pmol/L in patients with high-altitude pulmonary edema compared with 6.8 ± 0.7 pmol/L in the controls at the same altitude (P < 0.05). Elevated atrial natriuretic factor levels normalized to 7.5 ± 1.9 pmol/L (P < 0.05) during recovery in Denver (altitude, 1600 meters) 24 hours later. Plasma arginine vasopressin levels were 1.8 ± 0.37 pmol/L in patients with high-altitude pulmonary edema at diagnosis compared with 0.92 ± 0.28 pmol/L in controls (P = 0.07). The inappropriately elevated arginine vasopressin levels decreased to 1.29 ± 0.37 pmol/L during recovery (P < 0.025), but the lowered plasma sodium concentration had not normalized by discharge within 24-hours of transfer to Denver and averaged 135.8 ± 1.2 mmol/L. The pathophysiologic implications of these findings are discussed.
Robert L. Cosby, Aris M. Sophocles, Jacques A. Durr, Craig L. Perrinjaquet, Berne Yee, Robert W. Schrier. Elevated Plasma Atrial Natriuretic Factor and Vasopressin in High-Altitude Pulmonary Edema. Ann Intern Med. 1988;109:796–799. doi: 10.7326/0003-4819-109-10-796
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Published: Ann Intern Med. 1988;109(10):796-799.
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