J Korean Med Assoc.  2007 Nov;50(11):1005-1015. 10.5124/jkma.2007.50.11.1005.

Treatment and Prevention of High Altitude Illness and Mountain Sickness

• Kim YY
• Lee SM

• KMID: 2184948
• DOI: http://doi.org/10.5124/jkma.2007.50.11.1005

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.

Keyword

High-altitude illness; Acute mountain sickness; High-altitude cerebral edema; High-altitude pulmonary edema

MeSH Terms

Altitude Sickness*
Altitude*
Anorexia
Brain Edema
Dizziness
Fatigue
Headache
Humans
Nausea
Public Health
Pulmonary Edema
Vomiting

Figure

• 

  Figure 1 The relationship of altitude, barometric pressure, and oxygen saturation. As altitude increases and barometric pressure decreases inspired (PIO2) 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 PIO2 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).

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