Dr. Chris’s HAPE Cheat Sheet

Inflammation and altitude can cause low oxygen. Inflammation is commonly caused by viral infections such as colds or influenza, but can occasionally occur with bacterial infections such as strep throat or pneumonia. Low oxygen, or hypoxia, is the result of fluid collecting in the air sacs of the lungs, called pulmonary edema.

There are three types of high altitude pulmonary edema (HAPE).

  1. Classic HAPE, recognized for over a century. occurs in visitors to altitudes above 8000 ft (2500m) beginning during the first 48 hours after arrival. Symptoms include cough, congestion, trouble breathing, and fatigue, all worse with activity.
  2. Re-entry HAPE occurs in people who are living at altitude, travel to lower altitude, and develop symptoms during the first 48 hours after returning home
  3. High Altitude Resident Pulmonary Edema (HARPE) is a recently recognized illness that occurs mostly in children who have an underlying respiratory illness and live at altitude, with no recent history of travel. They have oxygen levels below 89 and lower but do not appear toxic. They are fatigued but rarely have increased work of breathing.
Parents are often worried their children won’t wear a canula for oxygen, but they don’t typically mind.

Treatment of HAPE is oxygen. There may also be signs of asthma or pneumonia which are treated with bronchodilators and antibiotics. Most people with pneumonia at altitude do NOT have hypoxia. All three types of HAPE can reoccur, but typically not with every arrival at altitude or viral illness. Many of these patients are told they have pneumonia again and again, or severe asthma, and are treated with inhalers and steroids. Usually, this adds nothing to their recovery.

A chest x-ray may show typical infiltrates seen with pulmonary edema, but in mild or early cases, can look normal. There is no blood test for HAPE. Oxygen should be used continuously at a rate that raises the oxygen saturation into the 90’s. Length of treatment may be as short as 2 days or as long as ten days

Most importantly, owning a pulse oximeter and measuring oxygen levels in anyone at altitude with symptoms of cough, congestion, fatigue and trouble breathing with exertion can keep people out of the ER and ICU. HAPE can rapidly progress to respiratory failure and death if not recognized and treated expediently.

4 thoughts on “Dr. Chris’s HAPE Cheat Sheet”

  1. Dr. Santos,
    Thanks for your information on HAPE. I have lived here for almost a year. I noticed that my pulse (even at resting) runs quite a bit higher here in Silverthorne. Can you please comment on that. What is too high for day-in, day-out for a woman at 52 years old.


    1. Interestingly, many people living at altitude run low heart rates, even in the 40’s in folks who are not particularly athletic. Others run high heart rates, in the 90’s. I would suggest if your resting heart rate is over 100 you should be checked. Recent arrivals to altitude will have a higher heart rate to compensate for hypoxia while they acclimate

  2. Hi – Are there any natural supplements to prevent altitude sickness that are safe for Children to take who are traveling to high altitudes?

    1. Though heavily promoted in stores around the mountains, there are no proven treatments that help with altitude adjustment besides oxygen (hours or days, not minutes), acetazolamide and a few other prescription drugs that have more side effects. Acetazolamide is an old medication that has been around for 50 years. Side effects of tinging in the hands and feet and taste change for carbonated beverages are usually well tolerated, especially at the lower dose now recommended. Some high altitude residents take this every time they go on vacation, starting 2 days before they return and continuing for 2 days after arrival. I have not tried using this in infants for altitude but there are are other medical uses that lead me to believe it would be safe to do so. It just may be that since infants don’t tell us about their headaches we don’t think about treating them prophylactically. There is a scale of symptoms that applies to babies, Lake Louise scale for altitude sickness. However, the symptoms are vague and overlap with normal infant behavior, so I have not found this helpful. Giving acetaminophen or ibuprofen to a fussy infant or child would be the NATURAL treatment, in my experience as a pediatrician working at altitude for 20 years. As always, anyone traveling to altitude would be wise to have a pulse oximeter to check on oxygen levels. This can be life-saving. Readings should be 90 and above.

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