High-Altitude Cerebral Edema (HACE)

Prevention

• Acetazolamide
• 125 - 250mg BID
• Need to stay hydrated (diuretic)
  
• Dexamethasone
• 4mg q12h
  

Treatment

• Descent (obviously) 
• at least 3000 feet
  
• Oxygen
• Nasal cannula unless HAPE also present -> then high flow
• Dexamethasone
• 10mg immediately then 4mg q6h
  

 Notes

• One questionable-quality clinical trial found no benefit of 125mg BID acetazolamide, and recommended 250. More recent higher-powered trial found significant benefit of 125mg BID.
• Acetazolamide/Dexamethasone not directly studied as treatment for HACE -> studied in context of Acute Mountain Sickness (AMS)