Abstract
Classic HAPE occurs in people who live in low altitude areas and travel to high altitude, while reentry HAPE happens in people living in high altitude, returning from travels near sea level.4 HARPE happens without changing altitude, and respiratory infections are the usually obvious trigger.2 In addition, genetic polymorphisms have been reported as a critical factor of HAPE predisposition.6,7 The exact incidence of HAPE in children is unknown; however, most literature reports an incidence between 0.5-15%.3 The risk of HAPE increases with rapid ascent above 2500 meters, recent respiratory tract infection, previous HAPE episode, and male sex. The underlying pathophysiology is an increase in pulmonary artery pressure, secondary to hypoxic pulmonary vasoconstriction, which results in leakage of fluids into the alveolar spaces.3,8 As per the Lake Louise diagnostic criteria for HAPE, a recent gain in altitude associated with at least two of the four typical symptoms (dyspnea at rest, cough, weakness/ decreased exercise performance, and chest tightness/congestion) and at least two of the four typical signs (crackles/ wheezes, central cyanosis, tachypnea, and tachycardia) are suggestive the diagnosis of HAPE.1 In addition, the chest radiograph is mandatory to confirm the diagnosis, which mainly shows bilateral opacities.4 If HAPE is left untreated, it can progress to severe respiratory failure and a mortality rate of up to 50%. Case Reports Patient 1 A 9-year-old female presented to the emergency room with acute onset of shortness of breath and cough for a 12-hour duration that happened after arriving at Abha city (her residential area 2200 Meters above sea level) from sea level area (Tehama area). SRBD scale is a validated pediatric sleep questionnaire that was described by a group of experts in pediatric sleep medicine with good sensitivity and specificity for obstructive sleep apnea diagnosis.10 According to the publishing group, a score of 7 out of 22 has most frequently been used as diagnostic of OSA.10 Physical examination showed she was in acute distress and severe hypoxia with SpO2 of 35% at room air; heart rate was 175 beats per minute, blood pressure was 120/ 72 mmHg (normal for age).