High-altitude pulmonary edema, severe shortness of breath due to accumulation of fluid in air sacs of the lungs, may occur in young, healthy, susceptible adults who ascend rapidly to altitudes in excess of 2500 m. The first symptom is usually dyspnea on exertion and a reduced exercise tolerance greater than expected for the altitude. A dry and annoying cough later becomes productive with blood¬stained sputum. Symptoms typically occur in the first two to four days after arrival at these high altitudes.
Symptoms may become much worse when these individuals engage in strenuous exercise at such high altitudes before they become acclimatized. Cough, short¬ness of breath, and reduced effort tolerance may increase within hours and progress to fulminant pulmonary edema, which is heralded by extreme shortness of breath, including shortness of breath when the individual is lying in bed (orthopnea).
On examination physical signs include fever, although this rarely exceeds 38.5°C and crepitations or crackles (rales) are heard over the chest with the stethoscope. High-altitude pulmonary edema is often accompanied by
nonspecific cerebral symptoms including headache, anor¬exia, nausea, vomiting, fatigue, and sleep disturbance.

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