altitude sickness
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Introduction
Also see high altitude periodic breathing.
Etiology
- modifiable risk factors
- higher destination altitude
- faster rate of ascent
- comorbid risk facors
Epidemiology
- elevations above 2500 meters (8200 feet)
- young age & level of physical fitness not protective
Pathology
- hypobaric hypoxia*
- hypoxia-induced hyperventilation diminishs PaCO2 towards the apneic threshold
- this decreases respiratory rate with resultant rise in PaCO2, increased respiratory drive & recurrent hyperventilation
- high-altitude periodic breathing ensues unless the cycle is broken
* atmospheric oxygen remains at 21% but barometric pressure diminishes amount of oxygen available[2]
Management
- descent to a lower altitude is curative
- gradual ascent
- spend one night at an intermediate altitude
- supplemental oxygen
- acetazolamide accelerates acclimatization by inducing a slight metabolic acidosis stimulating ventilation[5]
- nifedipine for high-altitude pulmonary edema
- dexamethasone for severe acute mountain sickness & cerebral edema (also descent to lower elevation)[2]
More general terms
More specific terms
- acute mountain sickness
- chronic mountain sickness (Monge's disease)
- high-altitude cerebral edema (HACE)
- high-altitude pulmonary edema
Additional terms
References
- ↑ Schoene RB. Illnesses at high altitude. Chest. 2008 Aug;134(2):402-16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18682459
- ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, American College of Physicians, Philadelphia 2015, 2018.
- ↑ West JB; American College of Physicians; American Physiological Society. The physiologic basis of high-altitude diseases. Ann Intern Med. 2004 Nov 16;141(10):789-800. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15545679
- ↑ Luks AM, Swenson ER, Bartsch P. Acute high-altitude sickness. Eur Respir Rev. 2017 Jan 31;26(143). pii: 160096. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28143879 Free Article
- ↑ 5.0 5.1 Furian M, Mademilov M, Buergin Aet al. Acetazolamide to prevent adverse altitude effects in COPD and healthy adults. NEJM Evidence 2022 Jan; 1:EVIDoa2100001. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38296630 https://evidence.nejm.org/doi/10.1056/EVIDoa2100006