HACE is the accumulation of fluid in the brain, which results in swelling and a depression of brain function that may result in death. It is caused by a rapid ascent to altitude without progressive acclimatization. Prevention of HACE is the same as for HAPE. HAPE and HACE may occur in experienced, well-acclimated mountaineers without warning or obvious predisposing conditions. They can be fatal; when the first symptoms occur, immediate descent is mandatory.
a. Contributing factors include rapid ascent to heights over 8,000 feet and aggravation by overexertion.
b. Symptoms of HACE include mild personality changes, paralysis, stupor, convulsions, coma, inability to concentrate, headaches, vomiting, decrease in urination, and lack of coordination. The main symptom of HACE is a severe headache. A headache combined with any other physical or psychological disturbances should be assumed to be manifestations of HACE. Headaches may be accompanied by a loss of coordination, confusion, hallucinations, and unconsciousness. These may be combined with symptoms of HAPE. The victim is often mistakenly left alone since others may think he is only irritable or temperamental; no one should ever be ignored. The symptoms may rapidly progress to death. Prompt descent to a lower altitude is vital.
c. Preventive measures include good eating habits, maintaining hydration, and using a gradual ascent to altitude. Rest, warmth, and oxygen at lower elevations enhance recovery. Left untreated, HACE can cause death.
d. Treatment for HACE includes:
• Dexamethasone injection immediately followed by oral dexamethasone.
• Supplemental oxygen.
• Rapid descent and medical attention.
• Use of a hyberbaric chamber if descent is delayed.
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