Altitude sickness

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(Redirected from Acute mountain sickness)
Altitude sickness
Classification and external resources
ICD-10 T 70.2
ICD-9 !02.0
DiseasesDB "#7$ 2!%&$
MedlinePlus 000&##
eMedicine med'#22$
MeSH (000$#2
Altitude sickness)also kno*n as acute mountain sickness (AMS), altitude illness, hypobaopathy, !the
altitude bends!, or sooche)is a patholo+ical effect of hi+h altitude on humans, caused ,y acute e-posure to
lo* partial pressure of o-y+en at hi+h altitude. .t commonly occurs a,o/e 2,000 metres (",000 feet).
1&2122
.t
presents as a collection of nonspecific symptoms, ac3uired at hi+h altitude or in lo* air pressure, resem,lin+ a
case of 4flu, car,on mono-ide poisonin+, or a han+o/er4.
1#2
.t is hard to determine *ho *ill ,e affected ,y
altitude sickness, as there are no specific factors that correlate *ith a suscepti,ility to altitude sickness.
5o*e/er, most people can ascend to 2,000 metres (",000 ft) *ithout difficulty.
Acute mountain sickness can pro+ress to hi+h altitude pulmonary edema (5A6) or hi+h altitude cere,ral
edema (5A7), *hich are potentially fatal.
122102
7hronic mountain sickness, also kno*n as Monge's disease, is a different condition that only occurs after /ery
prolon+ed e-posure to hi+h altitude.
1$2
Contents
& 7auses
2 (efinitions
# 8i+ns and symptoms
o #.& 6rimary symptoms
o #.2 8e/ere symptoms
0 6hysiolo+y
$ 6re/ention
o $.& Altitude acclimati9ation
o $.2 :edical treatment
o $.# ;-y+en enrichment
o $.0 ;ther methods
% Treatment
7 8ee also
" References
! -ternal links
Causes
The a/aila,le amount of o-y+en to sustain mental and physical alertness decreases *ith altitude. A/aila,le
o-y+en drops as the air density itself, the num,er of molecules (of ,oth o-y+en and nitro+en) per +i/en /olume,
drops as altitude increases.
5o*e/er, the percenta+e of o-y+en in air, at 2&<, remains almost unchan+ed up to 2&,000 metres (%!,000 ft).
1%2

The R:8 /elocities of diatomic nitro+en and o-y+en are /ery similar and thus no chan+e occurs in the ratio of
o-y+en to nitro+en.
(ehydration due to the hi+her rate of *ater /apor lost from the lun+s at hi+her altitudes may contri,ute to the
symptoms of altitude sickness.
172
The rate of ascent, altitude attained, amount of physical acti/ity at hi+h altitude, as *ell as indi/idual
suscepti,ility, are contri,utin+ factors to the onset and se/erity of hi+h=altitude illness.
Altitude sickness usually occurs follo*in+ a rapid ascent and can usually ,e pre/ented ,y ascendin+ slo*ly.
102

.n most of these cases, the symptoms are temporary and usually a,ate as altitude acclimati9ation occurs.
5o*e/er, in e-treme cases, altitude sickness can ,e fatal.
7lim,ers on :ount /erest often e-perience Altitude 8ickness.
De"initions
5i+h altitude> &,$00 to #,$00 metres (0,!00 to &&,$00 ft) = The onset of physiolo+ical effects of
diminished inspiratory o-y+en pressure (6i;
2
) includes decreased e-ercise performance and increased
/entilation (lo*er arterial 67;
2
). :inor impairment e-ists in arterial o-y+en transport (arterial o-y+en
saturation (8a;
2
) at least !0<), ,ut arterial 6;
2
is si+nificantly diminished. ?ecause of the lar+e num,er
of people *ho ascend rapidly to altitudes ,et*een 2,000 and 0,000 m, hi+h=altitude illness is common in
this ran+e.
1"2
@ery hi+h altitude> #,$00 to $,$00 metres (&&,$00 to &",000 ft) = :a-imum 8a;
2
falls ,elo* !0< as the
arterial 6;
2
falls ,elo* %0mm5+. -treme hypo-emia may occur durin+ e-ercise, durin+ sleep, and in
the presence of hi+h altitude pulmonary edema or other acute lun+ conditions. 8e/ere altitude illness
occurs most commonly in this ran+e.
1"2
-treme altitude> a,o/e $,$00 metres (&",000 ft) = :arked hypo-emia, hypocapnia, and alkalosis are
characteristic of e-treme altitudes. 6ro+ressi/e deterioration of physiolo+ic function e/entually outstrips
acclimati9ation. As a result, no permanent human ha,itation occurs a,o/e %,000 m. A period of
acclimati9ation is necessary *hen ascendin+ to e-treme altitudeA a,rupt ascent *ithout supplemental
o-y+en for other than ,rief e-posures in/ites se/ere altitude sickness.
1"2
Si#ns and symptoms
6eople ha/e different suscepti,ilities to altitude sicknessA for some other*ise healthy people, acute altitude
sickness can ,e+in to appear at around 2000 meters (%,$00 ft) a,o/e sea le/el, such as at many mountain ski
resorts, e3ui/alent to a pressure of "0 k6a.
1!2
This is the most fre3uent type of altitude sickness encountered.
8ymptoms often manifest themsel/es si- to ten hours after ascent and +enerally su,side in one to t*o days, ,ut
they occasionally de/elop into the more serious conditions. 8ymptoms include headache, fati+ue, stomach
illness, di99iness, and sleep distur,ance.
102
-ertion a++ra/ates the symptoms.
The Bake Bouise assessment system of A:8 is ,ased on a self=report 3uestionnaire as *ell as a 3uick clinical
assessment.
1&02
Those indi/iduals *ith the lo*est initial partial pressure of end=tidal p7;
2
(the lo*est concentration of car,on
dio-ide at the end of the respiratory cycle, a measure of a hi+her al/eolar /entilation) and correspondin+ hi+h
o-y+en saturation le/els tend to ha/e a lo*er incidence of acute mountain sickness than those *ith hi+h end=
tidal p7;
2
and lo* o-y+en saturation le/els.
1&&2
Pimay symptoms
5eadaches are the primary symptom used to dia+nose altitude sickness, althou+h a headache is also a symptom
of dehydration. A headache occurrin+ at an altitude a,o/e 2,000 metres (",000 feet C 7% k6a), com,ined *ith
any one or more of the follo*in+ symptoms, may indicate altitude sickness>
Back of appetite, nausea, or /omitin+
Fati+ue or *eakness
(i99iness or li+htheadedness
.nsomnia
6ins and needles
8hortness of ,reath upon e-ertion
Dose,leed
6ersistent rapid pulse
(ro*siness
-cessi/e flatulation
1"2
Eeneral malaise
6eripheral edema (s*ellin+ of hands, feet, and face)
Se$ee symptoms
8ymptoms that may indicate life=threatenin+ altitude sickness include>
6ulmonary edema (fluid in the lun+s)

o 8ymptoms similar to ,ronchitis

o 6ersistent dry cou+h
o Fe/er
o 8hortness of ,reath e/en *hen restin+
7ere,ral edema (s*ellin+ of the ,rain)

o 5eadache that does not respond to anal+esics

o Fnsteady +ait
o Eradual loss of consciousness
o .ncreased nausea
o Retinal hemorrha+e
The most serious symptoms of altitude sickness arise from edema (fluid accumulation in the tissues of the
,ody). At /ery hi+h altitude, humans can +et either hi+h altitude pulmonary edema (5A6), or hi+h altitude
cere,ral edema (5A7). The physiolo+ical cause of altitude=induced edema is not conclusi/ely esta,lished. .t
is currently ,elie/ed, ho*e/er, that 5A7 is caused ,y local /asodilation of cere,ral ,lood /essels in response
to hypo-ia, resultin+ in +reater ,lood flo* and, conse3uently, +reater capillary pressures. ;n the other hand,
5A6 may ,e due to +eneral /asoconstriction in the pulmonary circulation (normally a response to re+ional
/entilation=perfusion mismatches) *hich, *ith constant or increased cardiac output, also leads to increases in
capillary pressures. For those sufferin+ 5A7, de-amethasone may pro/ide temporary relief from symptoms in
order to keep descendin+ under their o*n po*er.
5A6 can pro+ress rapidly and is often fatal. 8ymptoms include fati+ue, se/ere dyspnea at rest, and cou+h that
is initially dry ,ut may pro+ress to produce pink, frothy sputum. (escent to lo*er altitudes alle/iates the
symptoms of 5A6.
5A7 is a life=threatenin+ condition that can lead to coma or death. 8ymptoms include headache, fati+ue,
/isual impairment, ,ladder dysfunction, ,o*el dysfunction, loss of coordination, paralysis on one side of the
,ody, and confusion. (escent to lo*er altitudes may sa/e those afflicted *ith 5A7.
Physiolo#y
The physiolo+y of altitude sickness is ,ased on the follo*in+ e3uation>
V
gas
CA'TD
k
(P
1
=P
2
)
Where V
gas
is the diffusion rate, A is the area of the lun+, T is the thickness of the lun+ mem,ranes, P
1
and P
2

are the differences in partial pressure of any +as=,ut most importantly CO
2
and O
2
=*here in hi+h altitudes the
partial pressure differences for O
2
are lo* and the differences in partial pressures for CO
2
are hi+h. Thus CO
2

*ill ha/e a hi+h diffusion out and ;2 *ill ha/e a lo* diffusion thou+h the al/eolar mem,ranes and into the
,lood.
The ,odyGs response to hi+h altitude includes the follo*in+>
Hrythropoietin I Hhematocrit and hemo+lo,in
H2,#=(6E (allo*s H release of ;2 and a ri+ht shift on the 5,=;2 disassociation cur/e)
Hrenal e-cretion of ,icar,onate (use of aceta9olamide can au+ment for treatment)
7hronic hypo-ic pulmonary /asoconstriction (can cause Ri+ht @entricular 5ypertrophy)
Pe$ention
Ascendin+ slo*ly is the ,est *ay to a/oid altitude sickness.
102
A/oidin+ strenuous acti/ity such as skiin+,
hikin+, etc. in the first 20 hours at hi+h altitude reduces the symptoms of A:8. Alcohol and sleepin+ pills are
respiratory depressants, and thus slo*s do*n the acclimati9ation process and should ,e a/oided. Alcohol also
tends to cause dehydration and e-acer,ates A:8. Thus, a/oidin+ alcohol consumption in the first 20J0" hours
at a hi+her altitude is optimal.
Altitude acclimati%ation
Altitude acclimati9ation is the process of adKustin+ to decreasin+ o-y+en le/els at hi+her ele/ations, in order to
a/oid altitude sickness.
1&22
;nce a,o/e appro-imately #,000 metres (&0,000 feet C 70 k6a), most clim,ers and
hi+h=altitude trekkers take the 4clim,=hi+h, sleep=lo*4 approach. For hi+h=altitude clim,ers, a typical
acclimati9ation re+imen mi+ht ,e to stay a fe* days at a ,ase camp, clim, up to a hi+her camp (slo*ly), and
then return to ,ase camp. A su,se3uent clim, to the hi+her camp then includes an o/erni+ht stay. This process
is then repeated a fe* times, each time e-tendin+ the time spent at hi+her altitudes to let the ,ody adKust to the
o-y+en le/el there, a process that in/ol/es the production of additional red ,lood cells.
1citation needed2
;nce the
clim,er has acclimati9ed to a +i/en altitude, the process is repeated *ith camps placed at pro+ressi/ely hi+her
ele/ations. The +eneral rule of thum, is to not ascend more than #00 metres (&,000 ft) per day to sleep. That is,
one can clim, from #,000 (&0,000 feet C 70 k6a) to 0,$00 metres (&$,000 feet C $" k6a) in one day, ,ut one
should then descend ,ack to #,#00 metres (&&,000 feet C %7.$ k6a) to sleep. This process cannot safely ,e
rushed, and this is *hy clim,ers need to spend days (or e/en *eeks at times) acclimati9in+ ,efore attemptin+ to
clim, a hi+h peak. 8imulated altitude e3uipment that produces hypo-ic (reduced o-y+en) air can ,e used to
acclimate to hi+h altitude, reducin+ the total time re3uired on the mountain itself.
1citation needed2
Altitude acclimati9ation is necessary for some people *ho mo/e rapidly from lo*er altitudes to intermediate
altitudes (e.+., ,y aircraft and +round transportation o/er a fe* hours), such as from sea le/el to ",000 feet
(2,000 m) as in many 7olorado, F8A mountain resorts. 8toppin+ at an intermediate altitude o/erni+ht can
alle/iate or eliminate occurrences of A:8.
Medical teatment
The dru+ aceta9olamide (trade name (iamo-) may help some people makin+ a rapid ascent to sleepin+ altitude
a,o/e 2,700 metres (!,000 ft), and it may also ,e effecti/e if started early in the course of A:8.
1&#2

Aceta9olamide can ,e taken ,efore symptoms appear as a pre/enti/e measure at a dose of &2$ m+ t*ice daily.
The /erest ?ase 7amp :edical 7entre cautions a+ainst its routine use as a su,stitute for a reasona,le ascent
schedule, e-cept *here rapid ascent is forced ,y flyin+ into hi+h altitude locations or due to terrain
considerations.
1&02
The 7entre su++ests a dosa+e of &2$ m+ t*ice daily for prophyla-is, startin+ from 20 hours
,efore ascendin+ until a fe* days at the hi+hest altitude or on descendin+A
1&02
*ith 2$0 m+ t*ice daily
recommended for treatment of A:8.
1&$2
The 7enters for (isease 7ontrol and 6re/ention (7(7) su++est a lo*er
dose for pre/ention of &2$ m+ aceta9olamide e/ery &2 hours.
1&%2
Aceta9olamide, a mild diuretic, *orks ,y
stimulatin+ the kidneys to secrete more ,icar,onate in the urine, there,y acidifyin+ the ,lood. This chan+e in
p5 stimulates the respiratory center to increase the depth and fre3uency of respiration, thus speedin+ the natural
acclimati9ation process. An undesira,le side=effect of aceta9olamide is a reduction in aero,ic endurance
performance. ;ther minor side effects include a tin+le=sensation in hands and feet, and it can make car,onated
drinks taste 4flat4. Althou+h a sulfonamide, aceta9olamide is a non=anti,iotic and has not ,een sho*n to cause
life=threatenin+ aller+ic cross=reacti/ity in those *ith a self=reported sulfa aller+y.
1&721&"21&!2
(osa+e of
&000 m+'day *ill produce a 2$< decrease in performance, on top of the reduction due to hi+h=altitude
e-posure.
1202
The 7(7 ad/ises that (e-amethasone ,e reser/ed for treatment of se/ere A:8 and 5A7 durin+
descents, and notes that Difedipine may pre/ent 5A6.
1&%2
A sin+le randomi9ed controlled trial found that sumatriptan may help pre/ent altitude sickness.
12&2
(espite their
popularity, antio-idant treatments ha/e not ,een found to ,e effecti/e medications for pre/ention of A:8.
1222

.nterest in phosphodiesterase inhi,itors such as sildenafil has ,een limited ,y the possi,ility that these dru+s
mi+ht *orsen the headache of mountain sickness.
12#2
A promisin+ possi,le pre/enti/e for altitude sickness is
myo=inositol trispyrophosphate (.T66), *hich increases the amount of o-y+en released ,y hemo+lo,in.
6rior to the onset of altitude sickness, i,uprofen is a su++ested non=steroidal anti=inflammatory and painkiller
that can help alle/iate ,oth the headache and nausea associated *ith A:8. .t has not ,een studied for the
pre/ention of cere,ral edema (s*ellin+ of the ,rain) associated *ith e-treme symptoms of A:8.
1202
For centuries, indi+enous peoples of the Americas such as the Aymaras of the Altiplano, ha/e che*ed coca
lea/es to try to alle/iate the symptoms of mild altitude sickness. .n 7hinese and Ti,etan traditional medicine, an
e-tract of the root tissue of Radix rhodiola is often taken in order to pre/ent the same symptoms, thou+h neither
of these therapies has ,een pro/en effecti/e in clinical study.
&'y#en enichment
.n hi+h=altitude conditions, o-y+en enrichment can counteract the hypo-ia related effects of altitude sickness. A
small amount of supplemental o-y+en reduces the e3ui/alent altitude in climate=controlled rooms. At
#,000 meters (&&,&$$ feet C %7 k6a), raisin+ the o-y+en concentration le/el ,y $ percent /ia an o-y+en
concentrator and an e-istin+ /entilation system pro/ides an effecti/e altitude of #,000 metres (&0,000 feet C
70 k6a), *hich is more tolera,le for surface=d*ellers.
12$2
&the methods
.ncreased *ater intake may also help in acclimati9ation
12%2
to replace the fluids lost throu+h hea/ier ,reathin+ in
the thin, dry air found at altitude, althou+h consumin+ e-cessi/e 3uantities (4o/er=hydration4) has no ,enefits
and may cause dan+erous hyponatremia. .tLs a +ood idea to limit alcohol intake the first day or so at hi+her
ele/ation as *ell.
;-y+en from +as ,ottles or li3uid containers can ,e applied directly /ia a nasal cannula or mask. ;-y+en
concentrators ,ased upon pressure s*in+ adsorption (68A), @8A, or /acuum=pressure s*in+ adsorption
(@68A) can ,e used to +enerate the o-y+en if electricity is a/aila,le. 8tationary o-y+en concentrators typically
use 68A technolo+y, *hich has performance de+radations at the lo*er ,arometric pressures at hi+h altitudes.
;ne *ay to compensate for the performance de+radation is to utili9e a concentrator *ith more flo* capacity.
There are also porta,le o-y+en concentrators that can ,e used on /ehicular (7 po*er or on internal ,atteries,
and at least one system commercially a/aila,le measures and compensates for the altitude effect on its
performance up to 0,000 meters (&#,000 ft). The application of hi+h=purity o-y+en from one of these methods
increases the partial pressure of o-y+en ,y raisin+ the Fi;
2
(fraction of inspired o-y+en).
(eatment
The only relia,le treatment and in many cases the only option a/aila,le is to descend. Attempts to treat or
sta,ili9e the patient in situ at altitude is dan+erous unless hi+hly controlled and *ith +ood medical facilities.
5o*e/er, the follo*in+ treatments ha/e ,een used *hen the patientGs location and circumstances permit>
;-y+en may ,e used for mild to moderate A:8 ,elo* #,700 m (&2,000 ft) and is commonly pro/ided
,y physicians at mountain resorts. 8ymptoms a,ate in &2J#% hours *ithout the need to descend.
For more serious cases of A:8, or *here rapid descent is impractical, a Eamo* ,a+, a porta,le plastic
hyper,aric cham,er inflated *ith a foot pump, can ,e used to reduce the effecti/e altitude ,y as much as
&,$00 meters ($,000 ft). A Eamo* ,a+ is +enerally used only as an aid to e/acuate se/ere A:8 patients,
not to treat them at altitude.
Aceta9olamide 2$0 m+ t*ice daily dosin+ assists in A:8 treatment ,y 3uickenin+ altitude
acclimati9ation.
1272
A study ,y the (enali :edical Research 6roKect concluded> 4.n esta,lished cases of acute mountain
sickness, treatment *ith aceta9olamide relie/es symptoms, impro/es arterial o-y+enation, and pre/ents
further impairment of pulmonary +as e-chan+e.4
12"2
The folk remedy for altitude sickness in cuador, 6eru and ?oli/ia is a tea made from the coca plant.
8ee mate de coca.
;ther treatments include steroids to reduce pulmonary or cere,ral edema, this may ,uy time to descend
,ut treats a symptom, it does not treat the underlyin+ A:8.
T*o studies in 20&2 sho*ed that .,uprofen %00 milli+rams three times daily *as effecti/e at decreasin+
the se/erity and incidence of A:8. ?ut it *as not clear if this affected 5A6 or 5A7.
12!21#02