Altitude Related Illness

Steven Podnos MD

Definition

• A multitude of medical problems are associated with ascent to altitude, ranging from minor to life threatening

• Hypoxia is considered a causative feature, but other elements of causation are uncertain

Syndromes

• Minor-impaired sleep• Major:• Acute Mountain Sickness (AMS)• High Altitude Pulmonary Edema (HAPE)• High Altitude Cerebral Edema (HACE)

AMS

• Almost universal with rapid ascent• Vague and inconsistent symptom complex:• Poor sleep, irritability, Headache, Dyspnea, GI

symptoms, Dizziness

AMS Factors

• Individual susceptibility• Altitude over 7000 feet• Rapid ascent• Pathophysiology –theory- hypoxia leads to

increased Cerebral Blood Flow, then edema due to hydrostatic pressure and capillary leak

AMS-Treatment

• Slow careful ascent prevents AMS• Acclimatization at an altitude or slight descent

helps• O2 resolve symptoms• Acetazolamide (Diamox)-125-250mg BID

begun one day before ascent and continued for two more days is effective

• Steroids are effective-prevention and Rx

HAPE

• 1-3 days after ascent• Cough, SOB, fatigue, can have bloody sputum• Signs: fever, rales, cyanosis• Hypoxia, tachycardia, tachpnea• Cause unclear-may be result of focal

hyperperfusion of PAs

HAPE-Rx

• Descent 1-3K feet very effective• O2• Hyperbaric bags

HACE

• Severe AMS• Mental Status Changes/Ataxia• Leads to severe impairment /death• May be rapidly progressive, even during sleep• Usually occurs after a few days at altitude

HACE Rx

• Rapid descent• O2• Steroids• Hyperbaric bag

Special Problems with Altitude

• CAD-slightly increased risk of exercise induced ischemia.

• COPD-mild increased symptoms (? Used to hypoxia), mild increased long term mortality

• Asthma-cold dry air is a trigger, but reduced allergens and reduced air density are helpful

• Sickle Cell disease-avoid altitude-even planes