Treatment and Prevention of High Altitude Illness and Mountain Sickness

You-Young Kim; Sang Min Lee

doi:10.5124/jkma.2007.50.11.1005

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Kim and Lee: Treatment and Prevention of High Altitude Illness and Mountain Sickness

Continuing Education Column

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2007; 50(11): 1005-1015.

Published online: 30 November 2007

DOI: https://doi.org/10.5124/jkma.2007.50.11.1005

Treatment and Prevention of High Altitude Illness and Mountain Sickness

You-Young Kim, MD¹, Sang Min Lee, MD²

¹Department of Internal Medicine, Seoul National University College of Medicine, Korea. youyoung@plaza.snu.ac.kr

²Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Korea. Sangminlee77@naver.com

Abstract

High-altitude illness is used to describe various symptoms that can develop in unacclimatized persons on ascent to high altitude. Symptoms usually include headache, anorexia, nausea, vomiting, fatigue, dizziness, and sleep disturbance. In fact, high-altitude illness comprises of acute mountain sickness (AMS) and its life-threatening complications, high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE). Since there are many travelers who visit high-altitude locations these days, high-altitude illness has become a public health problem. Therefore, physicians need to be familiar with the condition and be able to advise those who are going to reach high altitude how to prevent or minimize the illness and treat patients who suffer from it.

Keywords: High-altitude illness, Acute mountain sickness, High-altitude cerebral edema, High-altitude pulmonary edema

Figures and Tables

Figure 1

The relationship of altitude, barometric pressure, and oxygen saturation. As altitude increases and barometric pressure decreases inspired (P_IO₂) and arterial partial pressure of oxygen (Pao₂) including oxygen saturation (Sao₂) all decrease. Oxygen saturation is maintained till about 3000m. Although it can occur earlier, this is also the approximate altitude where altitude sickness starts being more obvious with rapid ascents. With ascent hyperventilation narrows the initial difference between P_IO₂ and Pao₂ to help maintain saturation of oxygen (1, 2).

Figure 2

At high altitudes hypoxemia can lead to overperfusion, elevated capillary pressure, and leakage from the cerebral microcirculation. Increased sympathetic activity has a central role in this process, and increased permeability of capillaries as a result of endothelial activation (inflammation) may also have a role. AMS and HACE seem to be a continuum (BBB: blood brain barrier, VEGF: vascular endothelial growth factor, Pcap: capillary pressure, iNOS: inducible nitric oxide synthase, HVR: hypoxic ventilatory response)(29).

Figure 3

Pathophysiology of high altitude pulmonary edema and the role the proposed agents sildenafil and theophylline may play (69).

Table 1

Differential diagnosis of high altitude illness(29)

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