High-altitude pulmonary edema: a case series of four patients from Nepal

Background and importance: High-altitude pulmonary edema (HAPE) is a potentially fatal, non-cardiogenic pulmonary edema that develops after rapid ascent above 2500 m. Its incidence is influenced by ascent rate, altitude, and individual susceptibility, with risk factors including overexertion, cold exposure, respiratory infection, and genetic predisposition. Despite Nepal’s extensive high-altitude trekking activity, published HAPE reports remain limited. This case series describes the clinical presentation, diagnostic features, and management outcomes of HAPE in Nepalese trekkers to promote early recognition and guide timely interventions. Methods: This retrospective case series included patients with HAPE managed at a tertiary care center in Nepal. Cases were identified from hospital records, and relevant literature was narratively reviewed to contextualize findings. Case presentation: Four previously healthy adults developed acute HAPE after rapid ascent above 4000 m in Nepal. They presented with dyspnea, cough, hypoxemia (SpO 2 55–60%), and bilateral crackles. Imaging confirmed non-cardiogenic pulmonary edema. All patients received supplemental oxygen, nifedipine, and supportive care, resulting in gradual clinical improvement and discharge within 3–5 days. Clinical discussion: This series highlights the clinical variability of HAPE and emphasizes early diagnosis, descent, and oxygen therapy as mainstays of treatment. Rapid ascent, excessive exertion, cold exposure, and preceding respiratory infection were identified as common triggers. Diagnosis relied on clinical assessment supported by imaging, including bedside ultrasound. All patients recovered with conservative management. Conclusion: HAPE is life-threatening but reversible with prompt recognition and management. Strengthening clinician awareness, training, and early diagnostic capacity in high-altitude regions is essential to reduce associated morbidity and mortality.