Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Emergency Department Management of Abnormal Uterine Bleeding in the Nonpregnant Patient right.
Case Presentation: High-Altitude Illness: Updates in Prevention, Identification, and Treatment
You have flown into Cusco, Peru (3400 m) to join a tour group that plans to hike the Inca Trail to Machu Picchu. During the evening of your arrival, you attend a welcome dinner with your group, where you meet a 29-year-old female fellow traveler from Miami who also flew in earlier in the day. As she gets up to leave the dinner early, she says she has a mild headache and feels generally run-down. You wonder if you should be concerned for her…
You recognized that the young woman with headache and fatigue had symptoms consistent with AMS. Because her initial presentation seemed mild after calculating a Lake Louise Score <5, you suggested that she halt her ascent and stay at the current elevation until her symptoms subsided and that she could treat her headache with over-the-counter analgesics as needed.
As an experienced trekker and physician, you told her that proper acclimatization with or without prophylactic medications such as acetazolamide would likely help mitigate or prevent progression of her symptoms. You also suggested that she ask someone to check on her for progression or improvement of symptoms throughout the course of the night since she was traveling alone. She followed your advice, and over the course of 24 hours, her symptoms resolved completely and she continued on her ascent, while paying special attention for symptom return.
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Last Updated on September 13, 2021