What is the first-line management for suspected High Altitude Cerebral Edema (HACE)?

• A. Administer diuretics and hydration.
• B. Administer antibiotics and rest at base camp.
• C. Hyperbaric oxygen therapy.
• D. Descent, high-flow oxygen, rest; avoid further ascent.

Answer: (D)

In suspected High Altitude Cerebral Edema, the priority is to remove the environmental cause of hypoxia and cerebral edema. The first-line approach is to descend to a lower altitude as quickly as possible, provide high-flow oxygen, and allow as much rest as feasible. Descending reduces the hypoxic stress driving the brain swelling, oxygenation improves cerebral tissue oxygen delivery, and rest lowers metabolic demands, all of which help stabilize the patient and prevent progression.

Avoiding further ascent is essential because additional exposure to low oxygen can worsen brain edema and hasten deterioration. Other options don’t address the underlying problem: diuretics and antibiotics aren’t treatments for cerebral edema caused by altitude, and hyperbaric oxygen therapy is a useful bridge only when descent isn’t immediately feasible.