1. Altitude Related Illness
Steven Podnos MD

2. Definition
• A multitude of medical problems are
associated with ascent to altitude, ranging
from minor to life threatening
• Hypoxia is considered a causative feature, but
other elements of causation are uncertain

3. Syndromes
• Minor-impaired sleep
• Major:
• Acute Mountain Sickness (AMS)
• High Altitude Pulmonary Edema (HAPE)
• High Altitude Cerebral Edema (HACE)

4. AMS
• Almost universal with rapid ascent
• Vague and inconsistent symptom complex:
• Poor sleep, irritability, Headache, Dyspnea, GI
symptoms, Dizziness

5. AMS Factors
• Individual susceptibility
• Altitude over 7000 feet
• Rapid ascent
• Pathophysiology –theory- hypoxia leads to
increased Cerebral Blood Flow, then edema
due to hydrostatic pressure and capillary leak

6. AMS-Treatment
• Slow careful ascent prevents AMS
• Acclimatization at an altitude or slight descent
helps
• O2 resolve symptoms
• Acetazolamide (Diamox)-125-250mg BID
begun one day before ascent and continued
for two more days is effective
• Steroids are effective-prevention and Rx

7. HAPE
• 1-3 days after ascent
• Cough, SOB, fatigue, can have bloody sputum
• Signs: fever, rales, cyanosis
• Hypoxia, tachycardia, tachpnea
• Cause unclear-may be result of focal
hyperperfusion of PAs

8. HAPE-Rx
• Descent 1-3K feet very effective
• O2
• Hyperbaric bags

9. HACE
• Severe AMS
• Mental Status Changes/Ataxia
• Leads to severe impairment /death
• May be rapidly progressive, even during sleep
• Usually occurs after a few days at altitude

10. HACE Rx
• Rapid descent
• O2
• Steroids
• Hyperbaric bag

11. Special Problems with Altitude
• CAD-slightly increased risk of exercise induced
ischemia.
• COPD-mild increased symptoms (? Used to
hypoxia), mild increased long term mortality
• Asthma-cold dry air is a trigger, but reduced
allergens and reduced air density are helpful
• Sickle Cell disease-avoid altitude-even planes