Wilderness Medicine Podcast #38: All Things Encephalopathy
Jun 19, 2025
Peter Hackett, an expert in high-altitude research from the University of Colorado, and Graham Brantzawadsky, an EMS specialist from the University of Utah, dive deep into the fascinating world of encephalopathy. They discuss the differences between hyponatremic encephalopathy and high-altitude cerebral edema, emphasizing hydration and sodium balance. Case studies highlight the complexities of diagnosing altitude illnesses. They even tackle hydration misconceptions in climbers and the critical need for accurate medical protocols in wilderness medicine.
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Military Cadet Hyponatremia Case
- A female Air Force cadet died from severe hyponatremia, not high altitude illness, despite initial assumptions.
- Vitreous sodium measurement at autopsy (127 mmol/L) confirmed the diagnosis and changed military hydration protocols.
Pulmonary Edema & Hyponatremia
- Pulmonary edema can occur with severe hyponatremic encephalopathy as non-cardiogenic neurogenic pulmonary edema.
- This complicates diagnosis since it mimics lung pathology commonly associated with high-altitude illness.
Marathon Risk at High Altitude
- Marathon running at 4,000 meters altitude carries high risk and is generally impractical without acclimatization.
- Many participants underestimate the time needed for proper altitude acclimatization before strenuous activities.