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Altitude sickness

Altitude sickness
Other namesHigh-altitude sickness,[1] altitude illness,[1] hypobaropathy, altitude bends, soroche
Sign displays "Caution! You are at 17586 ft (5360 m)"
Altitude sickness warning – Indian Army
SpecialtyEmergency medicine
SymptomsHeadache, vomiting, feeling tired, trouble sleeping, dizziness[1]
ComplicationsHigh-altitude pulmonary edema (HAPE),
high-altitude cerebral edema (HACE)[1]
Usual onsetWithin 24 hours[1]
TypesAcute mountain sickness, high-altitude pulmonary edema, high-altitude cerebral edema, chronic mountain sickness[2]
CausesLow amounts of oxygen at high elevation[1][2]
Risk factorsPrior episode, high degree of activity, rapid increase in elevation[2]
Diagnostic methodBased on symptoms[2]
Differential diagnosisExhaustion, viral infection, hangover, dehydration, carbon monoxide poisoning[1]
PreventionGradual ascent[1]
TreatmentDescent to lower altitude, sufficient fluids[1][2]
MedicationIbuprofen, acetazolamide, dexamethasone, oxygen therapy[2]
Frequency20% at 2,500 metres (8,000 ft)
40% at 3,000 metres (10,000 ft)[1][2]

Altitude sickness, the mildest form being acute mountain sickness (AMS), is a harmful effect of high altitude, caused by rapid exposure to low amounts of oxygen at high elevation.[1][2][3] People can respond to high altitude in different ways. Symptoms may include headaches, vomiting, tiredness, confusion, trouble sleeping, and dizziness.[1] Acute mountain sickness can progress to high-altitude pulmonary edema (HAPE) with associated shortness of breath or high-altitude cerebral edema (HACE) with associated confusion.[1][2] Chronic mountain sickness may occur after long-term exposure to high altitude.[2]

Altitude sickness typically occurs only above 2,500 metres (8,000 ft), though some are affected at lower altitudes.[2][4] Risk factors include a prior episode of altitude sickness, a high degree of activity, and a rapid increase in elevation.[2] Diagnosis is based on symptoms and is supported for those who have more than a minor reduction in activities.[2][5] It is recommended that at high altitude any symptoms of headache, nausea, shortness of breath, or vomiting be assumed to be altitude sickness.[6]

Sickness is prevented by gradually increasing elevation by no more than 300 metres (1,000 ft) per day.[1] Being physically fit does not decrease the risk.[2] Generally, descent and sufficient fluid intake can treat symptoms.[1][2] Mild cases may be helped by ibuprofen, acetazolamide, or dexamethasone.[2] Severe cases may benefit from oxygen therapy and a portable hyperbaric bag may be used if descent is not possible.[1] Treatment efforts, however, have not been well studied.[4]

AMS occurs in about 20% of people after rapidly going to 2,500 metres (8,000 ft) and in 40% of people after going to 3,000 metres (10,000 ft).[1][2] While AMS and HACE occurs equally frequently in males and females, HAPE occurs more often in males.[1] The earliest description of altitude sickness is attributed to a Chinese text from around 30 BCE that describes "Big Headache Mountains", possibly referring to the Karakoram Mountains around Kilik Pass.[7]

  1. ^ a b c d e f g h i j k l m n o p q r Ferri FF (2016). Ferri's Clinical Advisor 2017 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 590. ISBN 9780323448383.
  2. ^ a b c d e f g h i j k l m n o p q "Altitude Diseases – Injuries; Poisoning". Merck Manuals Professional Edition. May 2018. Retrieved 3 August 2018.
  3. ^ Rose, Stuart R.; Keystone, Jay S.; Connor, Bradley A.; Hackett, Peter; Kozarsky, Phyllis E.; Quarry, Doug (1 January 2006). "CHAPTER 15 – Altitude Illness". In Rose, Stuart R.; Keystone, Jay S.; Connor, Bradley A.; Hackett, Peter (eds.). International Travel Health Guide 2006-2007 (Thirteenth ed.). Philadelphia: Mosby. pp. 216–229. ISBN 978-0-323-04050-1. Archived from the original on 11 October 2022.
  4. ^ a b Simancas-Racines D, Arevalo-Rodriguez I, Osorio D, Franco JV, Xu Y, Hidalgo R (June 2018). "Interventions for treating acute high altitude illness". The Cochrane Database of Systematic Reviews. 6 (12): CD009567. doi:10.1002/14651858.CD009567.pub2. PMC 6513207. PMID 29959871.
  5. ^ Meier D, Collet TH, Locatelli I, Cornuz J, Kayser B, Simel DL, Sartori C (November 2017). "Does This Patient Have Acute Mountain Sickness?: The Rational Clinical Examination Systematic Review". JAMA. 318 (18): 1810–1819. doi:10.1001/jama.2017.16192. PMID 29136449. S2CID 205087288.
  6. ^ Weiss E (2005). "Altitude Illness". A Comprehensive Guide to Wilderness & Travel Medicine (3rd ed.). Adventure Medical Kits. pp. 137–141. ISBN 978-0-9659768-1-7. The Golden Rules of Altitude Illness 1) Above 8,000 feet, headache, nausea, shortness of breath, and vomiting should be considered to be altitude illness until proven otherwise. 2) No one with mild symptoms of altitude illness should ascend any higher until symptoms have resolved. 3) Anyone with worsening symptoms or severe symptoms of altitude illness should descend immediately to a lower altitude.
  7. ^ West JB (2013). High Life: A History of High-Altitude Physiology and Medicine. Springer. pp. 2–7. ISBN 9781461475736.

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