This is a series of case reports presented to the high altitude experts for discussion. It is a contribution to the knowledge of high altitude disease.

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Dear high altitude friends from around the globe:

Hope all is well with you. This is the first of a series of case reports related to high altitude medicine. Your are invited to make your
comments on the diagnosis.

You will learn and teach at the same time. Once we receive all the answers from the high altitude experts around the world in
around two weeks we will send a follow-up on the case.
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MEDICAL REPORT                          CASE NUMBER : 6081

NAME: W. S. M.
DATE: Jan/17/2003
DATE OF INITIAL CONSULTATION: Dec/26/2002
AGE:     32 SEX: M
BORN IN: WASHINGTON                RESIDENT OF LA PAZ: no
WEIGHT: 110.0 Kg   HEIGHT: 1.82 cm Blood Pressure: 130 / 90 mmHg  PULSE: 122 x'   TEMP: 37. °C
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PERSONAL MEDICAL RECORD: Smoked: 48 cigarettes per day, during  8.0 years, but stopped smoking since 10.0 years ago.
Alcoholic beverages: few  ; drinks  0 cups of coffee per day. Drugs: None. Allergies: none;  Genital-urinary: normal;
Gastro-intestinal: constipation; Other disease: gastro-esophageal reflux; Surgery: none; Accidents: none

FAMILY HISTORY: Father: throat cancer; Mother: breast cancer. Brothers: 2 healthy; Children: 1

PHYSICAL EXAMINATION: Head: normal. Eyes: normal. Ears: normal. Nose: normal. Throat: normal. Neck: normal. Thorax:
symmetrical. Heart: Second heart sound increased in pulmonary area and tachycardia. Lungs: normal breath sounds. Abdomen:
Depressible, not painful. Genitals: normal. Arms: normal. Legs: normal.

HISTORY: Patient arrives for the first time to La Paz, Bolivia located at 3510 m above sea level 4 days prior to consultation. He
had taken the “water pill” before coming. Upon arrival he referred some discomfort, shortness of breath, and headache, but felt
better the next day, having used oxygen by mask all night. After dinner, the second evening, he felt intense nausea, that gradually
subsided with oxygen administration sleeping through the night. The third day he felt better. However the fourth day he woke up with
intense headache. He also presented some cough with white sputum. He continued with nausea and was unable to tolerate any food.
He was given Fisherman´s friend, diamox (acetazolamide), Ibuprofen, cough medication and aspirin, but the headache and anorexia
continued and symptoms began to get worse. He arrived to consultation on his two feet, and immediately the following tests were
performed.

LABORATORY TESTS:

The blood hemogram revealed a  Hematocrit of 44 %,
                                                   Hemoglobin 14.7 gm/dl,
                                                   RBC count of 4.9 million/mm3,
                                                   WBC count of 13700 leucocytes/mm3
                                differential of 76 % neutrophils,
                                                    23 % lymphocytes
                                                      1 % monocytes.

Urinalyses showed traces of proteins, some RBCs and a hyaline cast.

Arterial blood gases revealed a PaO2 = 46 mmHg (N: 58-62),
                                                PaCO2 = 25 mmHg (N:28-32)
                                                pH = 7.41 (N: 7.38-7.42)
                                                HCO3 = 15.47 mEq/L (N: 17-21)
                                                SaO2 = 84 % (N: 90-92)
                                                BD ECF = –7 (N: -5).

In biochemistry Total proteins were 5.8 gm/dl (N: 6.1-7.9),
                        Blood glucose was 153.7 mg/dl (N: 60-110),
                        cholesterol, tryglicerides were normal.

Please click on each of the following links to see the results:

Chest X-rays (Posterior-anterior),
Chest X-rays (Lateral),
Electrocardiogram,
Oxygen saturation changes and breath-holding,
Spirometry,
Flow-volume curve,

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These questions were asked to the experts.

1) What is your diagnostic impression and what should be done ?
2) Do you think this is a dangerous condition ?
3) Please express your comments and let us know if you would like to receive more case reports on high altitude medicine.
4) If you wish we can keep your opinion anonymous.

Our best regards to all of you,
 
 
 

Prof. Dr. Gustavo Zubieta-Castillo (Sr)        &         Dr. Gustavo Zubieta-Calleja
High Altitude Pathology Institute (IPPA)
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Click here to read the FOLLOW-UP COMMENTS sent by world experts in high altitude medicine and physiology