Altitude Sickness Health Article

Definition

Altitude sickness is a general term encompassing a spectrum of disorders that occur at higher altitudes. Since the severity of symptoms varies with altitude, it is important to understand the range of the different altitudes that may be involved. High altitude is defined as height greater than 8, 000 feet (2, 438 m); medium altitude is defined as height between 5, 000 and 8, 000 feet (1, 524–2, 438 m); and extreme altitude is defined as height greater than 19, 000 feet (5, 791 m). The majority of healthy individuals suffer from altitude sickness when they reach very high altitudes. In addition, about 20% of people ascending above 9, 000 (2, 743 m) feet in one day will develop altitude sickness. Children under six years and women in the premenstrual part of their cycles may be more vulnerable. Individuals with preexisting medical conditions—even a minor respiratory infection—may become sick at more moderate altitudes.

Description

There are three major clinical syndromes that fall under the heading of altitude sickness: acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE). These syndromes are not separate, individual syndromes as much as they are a continuum of severity, all resulting from a decrease in oxygen in the air. AMS is the mildest, and the other two represent severe, life-threatening forms of altitude sickness.

Altitude sickness occurs because the partial pressure of oxygen decreases with altitude. (Partial pressure is a term applied to gases that is similar to the way the term concentration is applied to liquid solutions.) For instance, at 18, 000 feet (5, 486 m) the partial pressure of oxygen drops to one-half its value at sea level and, therefore, there is a substantially lower amount of oxygen available for the individual to inhale. This is known as hypoxia. Furthermore, since there is less oxygen to inhale, less oxygen reaches the blood. This is known as hypoxemia. These two conditions are the major factors that form the basis for all the medical problems associated with altitude sickness.

As a person becomes hypoxemic, his natural response is to breathe more rapidly (hyperventilate). This is the body's attempt to bring in more oxygen at a rapid rate. This attempt at alleviating the effects of the hypoxia at higher altitudes is known as acclimatization, and it occurs during the first few days. Acclimatization is a response that occurs in individuals who travel from lower to higher altitudes. There are groups of people who have lived at high altitudes (for example, in the Himalayan and Andes mountains) for generations, and they are simply accustomed to living at such altitudes, perhaps through a genetic ability.

Causes and symptoms

Acute mountain sickness (AMS) is a mild form of altitude sickness that results from ascent to altitudes higher greater than 8, 000 feet (2, 438 m)—even 6, 500 feet (1, 981m) in some susceptible individuals. Although hypoxia is associated with the development of AMS, the exact mechanism by which this condition develops has yet to be confirmed. It is important to realize that some individuals acclimatize to higher altitudes more efficiently than others. As a result, under similar conditions some will suffer from AMS while others will not. At present, the susceptibility of otherwise healthy individuals to contracting AMS cannot be accurately predicted. Of those who do suffer from AMS, the condition tends to be most severe on the second or third day after reaching the high altitude, and it usually abates after three to five days if they remain at the same altitude. However, it can recur if the individuals travel to an even higher altitude. Symptoms usually appear a few hours to a few days following ascent, and they include dizziness, headache, shortness of breath, nausea, vomiting, loss of appetite, and insomnia.

High-altitude pulmonary edema (HAPE) is a life-threatening condition that afflicts a small percentage of those who suffer from AMS. In this condition, fluid leaks from within the pulmonary blood vessels into the lung tissue. As this fluid begins to accumulate within the lung tissue (pulmonary edema), the individual begins to become more and more short of breath. HAPE is known to afflict all types of individuals, regardless of their level of physical fitness.

Typically, the individual who suffers from HAPE ascends quickly to a high altitude and almost immediately develops shortness of breath, a rapid heart rate, a cough productive of a large amount of sometimes bloody sputum, and a rapid rate of breathing. If no medical assistance is provided by this point, the patient goes into a coma and dies within a few hours.

High-altitude cerebral edema (HACE), the rarest and most severe form of altitude sickness, involves cerebral edema, and its mechanism of development is also poorly understood. The symptoms often begin with those of AMS, but neurologic symptoms such as an altered level of consciousness, speech abnormalities, severe headache, loss of coordination, hallucinations, and even seizures. If no intervention is implemented, death is the result.