In this situation, the people have a problem with kidney function due to a filtration problem involving proteins. Proteins spills through the kidney and into the urine. The heavy loss of protein in the urine (over grams per day) with its accompanying edema is termed the nephrotic syndrome . Nephrotic syndrome results in a reduction in the concentration of albumin in the blood (hypoalbuminemia). Since albumin helps to maintain blood volume in the blood vessels, a reduction of fluid in the blood vessels occurs. The kidneys then register that there is depletion of blood volume and attempt to retain salt. Consequently, fluid moves into the interstitial spaces causing pitting edema.
Treatment is simple – immediate descent. Even if HACE starts at night descent must still be started immediately as any delay could prove to be fatal. This could be difficult because the person will be confused and staggering, and so will need people to assistthem. Descent should be to the last point when the person woke up and felt well. This is likely to be the place where the person slept two nights ago because cases of HACE generally only develop when a person with mild symptoms of AMS proceed upwards. This
should be at the least 500m. Once a lower place has been reached maximum rest is advised.
Ambulatory Care: Cardiac rehabilitation begins as soon as the patient is physiologically stable. The goal of cardiac rehabilitation is to have the patient establish a healthy lifestyle that minimizes the risk of another MI. Ambulation is slowly increased, and a low-level treadmill test may be ordered before discharge to determine exercise tolerance and the risk of future heart attacks. Patients are taught not only to measure their pulse but also to assess their response to exercise in terms of fatigue, ease of breathing, and perceived workload. Following discharge, exercise is slowly increased, first while being monitored closely by supervised cardiac rehabilitation, and then more independently. The patient also receives information about a low saturated fat, low cholesterol, low calorie diet, such as the DASH eating plan (Dietary Approaches to Stop Hypertension), resumption of sexual activity, work, and other activities. The patient is taught about desired and adverse affects of all medications: aspirin therapy is usually prescribed as ongoing antiplatelet therapy (with or without clopidogrel), but patients should be warned about the risk of bleeding and be advised to avoid products containing ibuprofen, which blocks aspirin’s antiplatelet effects. Smoking cessation is an important preventive for future MIs. High blood pressure, obesity, adverse cholesterol levels, and diabetes mellitus also should be carefully managed to help prevent future MIs. Alcohol intake should be limited to 1 drink daily (women), 2 drinks daily (men). Opportunities are created for patients and families to share feelings and receive realistic reassurance about common fears.