Mountain sickness: physiological challenges, diagnosis and treatment
DOI:
https://doi.org/10.56294/hl2024.252Keywords:
Mountain sickness, altitude, hypobaric hypoxia, high-altitude pulmonary edemaAbstract
INTRODUCTION. The first descriptions of altitude sickness were made in (1540-1600). Nowadays, different cities in the world are at high altitude, for example Qinghai-Tibetan Plateau in China occupies an area of almost 2.5 million inhabitants km2, with an average elevation of over 4,500 m. Altitude sickness should be a major concern for anyone who normally resides at sea level. METHOD. A search for information was carried out in the period August-December 2024 in the SciELO, LILACS, Scopus, PubMed-MedLine databases, the Google Scholar search engine, as well as in the ClinicalKeys services. RESULTS AND DISCUSSION. The partial pressure of arterial oxygen (PaO2 ) decreases with altitude, which produces progressive tissue hypoxia. The normal compensatory response to hypobaric hypoxia is called acclimatization. Its main characteristic is increased ventilation. The ability to acclimatize varies widely among individuals and depends on many factors, including the degree of hypoxic stress (rate of ascent, altitude reached), the intrinsic ability of the individual to compensate for the decrease in PaO2, and extrinsic factors. Progressive ascent produces greater hypoxic stress, requiring greater degrees of physiological and behavioral adaptations to preserve function. The more rapid the ascent and the higher the altitude, the greater the stress. Below 1500 m, symptoms of high altitude illness are generally not manifest. From approximately 1500 to 2500 m, symptoms are generally mild, if experienced at all. From approximately 2500 m, mild to moderate symptoms become quite common among unacclimatized visitors after a rapid ascent. As a general rule, people who normally reside below 1500 m should avoid an abrupt ascent to altitudes above 2800 m for sleeping. Sedative-hypnotics should be avoided during acclimatization. Abstinence from alcohol is safest
References
1. National Tibetan Plateau Data Center, Du Y. Population statistics of Qinghai-Tibet Plateau (1952-2016). Beijing, China. Available at: https://data.tpdc.ac.cn/zh-hans/data/f8ba120e-1afa-43ff-9826-5e44507d3373/
2. Ward, Milledge and West’s High Altitude Medicine and Physiology. 6th ed. Boca Raton: CRC Press; 2021. Available at : https://www.crcpress.com
3. Simon RB, Simon DA. Preparing for travel to high altitudes. Nursing. 2012;42(9):66-67. Available at: https://doi.org/10.1097/01.nurse.0000418627.60207.42
4. West JB, Schoene RB, Milledge JS, Luks AM. High Altitude Medicine and Physiology. 5th ed. London, UK: CRC Press; 2012. Available at: https://doi.org/10.1201/b13015
5. Gallagher SA, Hackett PH, Rosen JM. High-altitude illnesses: physiology, risk factors, prevention, and treatment. J Am Osteopath Assoc. 2013 Jun;113(6):468-74. Available at: https://pubmed.ncbi.nlm.nih.gov/23908794/
6. Stream JO, Grissom CK. Update on high-altitude pulmonary edema: pathogenesis, prevention, and treatment. Wilderness Environ Med 2008; 19:293. Available at: 10.1580/07-WEME-REV-173.1
7. Schoene RB. Enfermedades a gran altura. Pecho 2008; 134:402.
8. Ward, Milledge and West's High Altitude Medicine and Physiology, 2021.6.a ed, Luks A, Ainslie, P N, Lawley JS, Roach RC, Simonson TS (Eds), CRC Press, Boca Raton 2021.4
9. Basnyat B, Murdoch DR. Mal de altura. Lancet 2003; 361:1967. Available at:10.1016/S0140-6736(03)13591-X
10. Bärtsch P, Swenson ER. Acute high-altitude illnesses. N Engl J Med. 2013 Oct 24;369(17):1666-7. Available at: 10.1056/NEJMc1309747
11. Luks AM, Auerbach PS, Freer L, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. High Alt Med Biol. 2019;20(3):146-154. Available at: https://doi.org/10.1089/ham.2019.0040.
12. Meier D, Collet TH, Locatelli I, et al. Does this patient have acute mountain sickness?: The Rational Clinical Examination systematic review. JAMA. 2017;318:1810. Available at: https://doi.org/10.1001/jama.2017.14987.
13. Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. Eur Respir Rev. 2017;26. Available at: https://doi.org/10.1183/16000617.0014-2017.
14. Grissom CK, Roach RC, Sarnquist FH, Hackett PH. Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange. Ann Intern Med. 1992;116:461. Available at: https://doi.org/10.7326/0003-4819-116-6-461.
15. Grissom CK, Roach RC, Sarnquist FH, Hackett PH. Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange. Ann Intern Med. 1992;116:461. Available at: https://doi.org/10.7326/0003-4819-116-6-461.
16. Hackett PH, Roach RC, Wood RA, et al. Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med. 1988 Oct;59(10):950-4. Available at: https://pubmed.ncbi.nlm.nih.gov/3190622/.
17. Keller HR, Maggiorini M, Bärtsch P, Oelz O. Simulated descent v dexamethasone in treatment of acute mountain sickness: a randomised trial. BMJ. 1995 May 13;310(6989):1232-5. Available at: https://doi.org/10.1136/bmj.310.6989.1232
18. Hackett P, Luks AM, Lawley JS, Roach RC. High Altitude Medicine and Pathophysiology. In: Auerbach PA, editor. Wilderness Medicine. 7th ed. Philadelphia: Elsevier; 2017. p. 8-28. Available at: https://www.elsevier.com/books/wilderness-medicine/auerbach/978-0-323-40476-2
19. Luks AM, Hackett PH. Medical conditions and high-altitude travel. N Engl J Med. 2022;386:364. Available at: https://doi.org/10.1056/NEJMc2114896
20. Burtscher J, Swenson ER, Hackett PH, et al. Flying to high-altitude destinations: Is the risk of acute mountain sickness greater? J Travel Med. 2023;30. Available at: https://doi.org/10.1093/jtm/taad051
21. McIntosh SE, Opacic M, Freer L, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update. Wilderness Environ Med. 2014;25:S43. Available at: https://doi.org/10.1016/j.wem.2014.08.003
22. Durmowicz AG, Noordeweir E, Nicholas R, Reeves JT. Inflammatory processes may predispose children to high-altitude pulmonary edema. J Pediatr. 1997;130:838. Available at: https://doi.org/10.1016/S0022-3476(97)70108-9
23. Bloch KE, Turk AJ, Maggiorini M, et al. Effect of ascent protocol on acute mountain sickness and success at Muztagh Ata, 7546 m. High Alt Med Biol. 2009;10:25. Available at: https://doi.org/10.1089/ham.2008.1031
24. Beidleman BA, Fulco CS, Muza SR, et al. Effect of six days of staging on physiologic adjustments and acute mountain sickness during ascent to 4300 meters. High Alt Med Biol. 2009;10:253. Available at: https://doi.org/10.1089/ham.2009.1052
25. Beidleman BA, Fulco CS, Muza SR, et al. Effect of six days of staging on physiologic adjustments and acute mountain sickness during ascent to 4300 meters. High Alt Med Biol. 2009;10:253. Available at: https://doi.org/10.1089/ham.2009.1052
26. Schneider M, Bernasch D, Weymann J, et al. Acute mountain sickness: influence of susceptibility, preexposure, and ascent rate. Med Sci Sports Exerc. 2002;34:1886. Available at: https://doi.org/10.1097/00005768-200211000-00017
27. Dehnert C, Böhm A, Grigoriev I, et al. Sleeping in moderate hypoxia at home for prevention of acute mountain sickness (AMS): a placebo-controlled, randomized double-blind study. Wilderness Environ Med. 2014;25:263. doi: 10.1016/j.wem.2014.05.005. Available at: https://doi.org/10.1016/j.wem.2014.05.005
28. Graham LE, Basnyat B. Cerebral edema in the Himalayas: too high, too fast! Wilderness Environ Med. 2001;12:62. doi: 10.1580/1080-6032(2001)012[0062:CEITHT]2.0.CO;2. Available at: https://doi.org/10.1580/1080-6032(2001)012[0062:CEITHT]2.0.CO;2.
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Copyright (c) 2024 Jhossmar Cristians Auza-Santivañez, Paul Cardozo Gil, Mildred Ericka Kubatz La Madrid, Ingrid Neysa Cabezas-Soliz, Jorge Márquez-Molina, Yamila Cruz Cruz, Dilma Villca-Villca, Ritdber Alfredo Quispe Sarmiento (Author)
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