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Rambam Maimonides Medical Journal

High-Altitude Illnesses: Physiology, Risk Factors, Prevention, and Treatment
Andrew T. Taylor, M.D.*
Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA

ABSTRACT High-altitude illnesses encompass the pulmonary and cerebral syndromes that occur in nonacclimatized individuals after rapid ascentto high altitude. The most common syndrome is acute mountain sickness (AMS) which usually begins within a few hours of ascent and typically consists of headache variably accompanied by loss of appetite, nausea, vomiting, disturbed sleep, fatigue, and dizziness. With millions of travelers journeying to high altitudes every year and sleeping above 2,500 m, acute mountain sickness is a wide-spreadclinical condition. Risk factors include home elevation, maximum altitude, sleeping altitude, rate of ascent, latitude, age, gender, physical condition, intensity of exercise, preacclimatization, genetic make-up, and pre-existing diseases. At higher altitudes, sleep disturbances may become more profound, mental performance is impaired, and weight loss may occur. If ascent is rapid, acetazolamide canreduce the risk of developing AMS, although a number of high-altitude travelers taking acetazolamide will still develop symptoms. Ibuprofen can be effective for headache. Symptoms can be rapidly relieved by descent, and descent is mandatory, if at all possible, for the management of the potentially fatal syndromes of high-altitude pulmonary and cerebral edema. The purpose of this review is tocombine a discussion of specific risk factors, prevention, and treatment options with a summary of the basic physiologic responses to the hypoxia of altitude to provide a context for managing highaltitude illnesses and advising the non-acclimatized high-altitude traveler.
KEY WORDS: Acute mountain sickness, high-altitude pulmonary edema, high-altitude cerebral edema,

acetazolamideAbbreviations: AMS, acute mountain sickness; CSF, cerebral spinal fluid; CT, computed tomography; H+, hydrogen ion;
H2CO3, carbonic acid; HACE, high-altitude cerebral edema; HAPE, high-altitude pulmonary edema; HCO3-, bicarbonate; Hg, mercury; HVR, hypoxic ventilatory response; m, meters; mL, milliliters; mm, millimeters; MRI, magnetic resonance imaging; O2, oxygen; PaCO2, partial pressure of arterial carbondioxide; PAO2, partial pressure of oxygen in the alveoli; PCO2, partial pressure of carbon dioxide; PDE, phosphodiesterase; PiO2, partial pressure of inspired oxygen; PO2, partial pressure of oxygen; RQ, respiratory quotient; SaO2, arterial oxygen saturation of hemoglobin.

Citation: Taylor AT. High-altitude illnesses: Physiology, risk factors, prevention, and treatment. RMMJ 2011;2(1):e0022.doi:10.5041/RMMJ.10022

Copyright: © 2011 Andrew T. Taylor. This is an open-access article. All its content, except where otherwise noted, is distributed
under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Conflictof interest: No potential conflict of interest relevant to this article was reported. * E-mail: ataylor@emory.edu

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January 2011 w Volume 2 w Issue 1 w e0022

High-Altitude Illnesses

High-altitude illnesses encompass the pulmonary Table 1. Definitions of high, very high, and extreme and cerebral syndromes that occur in non- altitude. acclimatized individualsshortly after rapid ascent to high altitude. The most common of these synAltitude Meters Feet dromes is acute mountain sickness (AMS) which is described in the editorial, “See Nuptse and Die”, as “vile at best, fatal at worst and an entity to be High altitude 1,500-3,500 5,000-11,500 avoided”.1 Nuptse, meaning west peak, rises next to Mount Everest and is commonly viewed from Very high altitude...