title: Elevated plasma atrial natriuretic factor and vasopressin in high-altitude pulmonary edema.
abstract: A diagnosis of acute high-altitude pulmonary edema was made in five male skiers (age, 35.0 +/- 1.8 years) by history and physical examination and was confirmed by a characteristic chest radiogram showing alveolar infiltrates associated with a normal cardiac silhouette. Five healthy age- and sex-matched subjects with similar physical activity at the same altitude served as controls. Plasma sodium was 135.0 +/- 1.5 mmol/L in the acutely ill patients compared with 144.0 +/- 3.3 mmol/L in the controls (P less than 0.025). Mean plasma atrial natriuretic factor immunoreactivity averaged 17.6 +/- 5.6 pmol/L in patients with high-altitude pulmonary edema compared with 6.8 +/- 0.7 pmol/L in the controls at the same altitude (P less than 0.05). Elevated atrial natriuretic factor levels normalized to 7.5 +/- 1.9 pmol/L (P less than 0.05) during recovery in Denver (altitude, 1600 meters) 24 hours later. Plasma arginine vasopressin levels were 1.8 +/- 0.37 pmol/L in patients with high-altitude pulmonary edema at diagnosis compared with 0.92 +/- 0.28 pmol/L in controls (P = 0.07). The inappropriately elevated arginine vasopressin levels decreased to 1.29 +/- 0.37 pmol/L during recovery (P less than 0.025), but the lowered plasma sodium concentration had not normalized by discharge within 24-hours of transfer to Denver and averaged 135.8 +/- 1.2 mmol/L. The pathophysiologic implications of these findings are discussed.
authors.affiliation: University of Colorado School of Medicine.
authors.forename: R L
authors.initials: RL
authors.lastname: Cosby
authors.forename: A M
authors.initials: AM
authors.lastname: Sophocles
authors.forename: J A
authors.initials: JA
authors.lastname: Durr
authors.forename: C L
authors.initials: CL
authors.lastname: Perrinjaquet
authors.forename: B
authors.initials: B
authors.lastname: Yee
authors.forename: R W
authors.initials: RW
authors.lastname: Schrier
mesh_terms: D000208:Acute Disease; D000328:Adult; D000450:Aldosterone / Q000097:blood; D000532:Altitude Sickness / Q000097:blood*; D001127:Arginine Vasopressin / Q000097:blood*; D009320:Atrial Natriuretic Factor / Q000097:blood*; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D006801:Humans; D000860:Hypoxia / Q000097:blood*; D008297:Male; D011654:Pulmonary Edema / Q000097:blood* / Q000209:etiology; D012083:Renin / Q000097:blood; D012964:Sodium / Q000097:blood
chemical_list: D001127:Arginine Vasopressin; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D012964:Sodium; D003404:Creatinine; D012083:Renin