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HIGH ALTITUDE MEDICINE

WHAT DEFINES HIGH ALTITUDE?


● High altitude is a hypoxic environment
● High altitude to a physiologist starts around 2440m/8000ft, the altitude where
the body senses decrease in the oxygen level
ACCLIMATIZATION
● Physiological changes that occur in an altitude in response to hypoxia
● Includes:
○ Increased rate and depth of breathing (hyperventilation)
○ Increased production of red cells
○ Increased renal excretion of bicarbonate in response to respiratory alkalosis
○ Increased cardiac output
HIGH ALTITUDE ILLNESS

Risk factors
● Rapid ascend from
low to high altitudes
● Obesity
● Medical ● Acute Mountain Sickness
comorbidities ● High Altitude Pulmonary Edema (HAPE)
● High Altitude Cerebral Edema (HACE)
ACUTE MOUNTAIN SICKNESS
● Occurs in low landers, who ascend to very high altitude over 1-2 days for the
first time
● Symptoms
○ Headache
○ Anorexia, nausea, vomitting
○ Sleep difficulties
○ Peripheral and facial Edema (fluid retention is a hallmark of AMS)
Lake Louise Acute
Mountain Sickness Self
Questionnaire
Treatment
● Stop ascent, adequate hydration
● Symptomatic treatment
○ Nausea/vomitting: T. Ondansetron 4 mg TDS/QID
○ Headache: T. Ibuprofen 600mg TDS
● Oxygen therapy
● Acetazolamide (Diamox)
○ Carbonic anhydrase inhibitor
○ Promotes bicarbonate diuresis, decreasing pH, stimulating breathing
○ 125/250mg BD, take 24 hrs before ascent and continue until max altitude
○ Contraindicated in patient allergic to sulfa
● If symptoms not improved or worsened, descend
HIGH ALTITUDE PULMONARY EDEMA
● Non cardiogenic pulmonary edema
● Most lethal altitude illness, but easily reversible
● Onset is 1-4 days after ascent
● Symptoms
○ SOB
○ dry/wet cough
○ Hemoptysis
○ Tachycardia
○ Crackles in lungs
○ Altered level of consciousness
Treatment
● Supplemental oxygen to keep spo2>85-90%
● Gamow bag
● Nifedipine
○ CCB, reduce pulmonary hypertension
○ 20mg TDS
● Phosphodiesterase inhibitor
○ Eg. viagra
○ 25mg TDS
HIGH ALTITUDE CEREBRAL EDEMA
● Progressive neurological deterioration in someone with AMS /HAPE
● Symptoms
○ Loss of coordination (ataxia)
○ Declining level of consciousness
○ Behavioral change
○ Drowsiness, confusion, comatose
● MEDICAL EMERGENCY
Treatment
● Descend is critical
● Supplemental oxygen
● Gamow bag
● IM/PO dexamethasone 8mg Stat, followed by 4mg QID