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You are working locum tenens in Breckenridge, Colorado, and see a 2 year old boy with irritability, vomiting, and poor appetite. He has no fever or diarrhea and no one else in his family is affected. The family landed in the Denver airport the night before and drove to Breckenridge. The patient awoke this morning with these symptoms.
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April 5, 2023 at 10:32 pm
A) Oxygen
While the child may simply have a viral gastritis or food poisoning syndrome coincidentally at the same time as travelling to an area with elevation > 2000m (6500 ft), acute mountain sickness (AMS) is also a likely diagnosis. AMS symptoms typically start 6-12 hours after arriving at altitude, and include headache, lightheadedness, nausea, vomiting, and poor appetite. Recognition is more difficult in young non-verbal children, who may present more vaguely with fussiness and irritability. Oral analgesics, ondansetron, and oxygen are initial therapies for mild AMS. For moderate to severe AMS, acetazolamide may be used to speed acclimatization, and dexamethasone to improve symptoms. A more severe manifestation of altitude sickness, High Altitude Cerebral Edema (HACE) presents with neurological deficits and signs of encephalopathy. HACE is treated with immediate descent, dexamethasone, oxygen, and consideration of portable hyperbaric therapy if available.