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Elevated Plasma Atrial Natriuretic Factor and Vasopressin in High-Altitude Pulmonary Edema

Robert L. Cosby, MD; Aris M. Sophocles, MD; Jacques A. Durr, MD; Craig L. Perrinjaquet, MD; Berne Yee, MD; and Robert W. Schrier, MD
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Grant Support: Supported in part by grant BRSG-05-357 from the Biomedical Research Grant Program; NIH Grant DK19928; and NIH Training Grant DK07135. Dr. Cosby was supported by a grant from the National Kidney Foundation of the Rocky Mountain Region.

Requests for Reprints: Robert W. Schrier, MD, University of Colorado School of Medicine, 4200 East Ninth Avenue, Box B178, Denver, CO 80262.

Current Author Addresses: Dr. Cosby: 6885 W. 91st Court, #19207, Westminster, CO 80030.

Dr. Sophocles: 2331 Forest Street, Denver, CO 80207.

Dr. Durr: University of Colorado School of Medicine, 4200 East Ninth Avenue, Box C281, Denver, CO 80262.

Dr. Perrinjaquet: 1 Cedar Lane, Woodside, CA 94062.

Dr. Yee: 15814 N. 12th Street, Phoenix, AZ 85022.

Dr. Schrier: University of Colorado School of Medicine, 4200 East Ninth Avenue, Box B178, Denver, CO 80262.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(10):796-799. doi:10.7326/0003-4819-109-10-796
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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.





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