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Re: altitude questionFrom: DoctorJoe@aol.comSun Aug 25 09:32:00 1996
<<My client moved to a higher elevation prior to pregnancy.B.P. was occassionally labile.Now at about 33 wks, B.P. is up when she is home, down when she returns to the lower elevation.>> Hmmmmm. Well, from a physics standpoint, the atmospheric pressure (per square inch of skin area) is lower at higher altitudes, allowing more intravascular fluid to shift to the extracellular space (simply because pressure is released on the extracellular space, like taking off a pressure suit). When your client comes back down the mountain, this should reverse itself (and the extracellular fluid should shift somewhat back into the vascular space). Alsl, if a patient is "mildly" preeclamptic, we can help their manifestations (e.g., blood pressure) somewhat by expanding the intravascular volume. This has been done and published (anyone have the references? Somewhere back in the 1980s, I think...). Soooooooo, let's make a leap of logic: If your patient is showing signs of preeclampsia at higher altitudes and comes DOWN the mountain, she has, in effect, treated herself somewhat by the mechanism of expansion of the intravascular volume. I would expect, however, that she will ultimately show more and more symptoms until delivery cures her. Anyone else have any ideas? ************************************************* doctorjoe@aol.com "All things are connected. Joseph Pastorek, MD Some things are just more Department of OB-GYN connected than others." LSU Medical Center - Dirk Gently New Orleans, LA U.S.A. *************************************************
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