Altitude Sickness

Altitude sickness, frequently known as acute mountain sickness (AMS), results from reduced oxygen levels and lower air pressure at high altitudes. This condition can present symptoms such as nausea, vomiting, dizziness, fatigue, rapid heartbeat, and shortness of breath. In severe cases, it may necessitate hospitalization. Common treatments include supplying supplemental oxygen, descending to a lower altitude, or taking medications. Carbonic anhydrase inhibitors like acetazolamide (Diamox Sequels) are often prescribed to alleviate symptoms.

Causes

Altitude sickness arises when the body struggles to adjust to the decreased oxygen levels at high elevations. Contributing factors include:

• A decrease in air pressure with higher altitudes results in less oxygen per breath.

• Ascending to heights above 8,000 feet too quickly, without allowing time to acclimatize.

• Rapid ascents, such as flying to high-altitude locations.

• Engaging in vigorous physical activities soon after reaching high altitudes.

• Alcohol consumption or certain medications that increase risk.

• Previous instances of altitude sickness.

• Individuals new to high altitudes are at a greater risk, potentially leading to severe headaches, nausea, or fluid accumulation in the lungs or brain.

Symptoms

Altitude sickness manifests when ascending rapidly to high altitudes, leading to a range of symptoms due to reduced oxygen levels. Key symptoms include:

• Headache, the most prevalent symptom.

• Nausea and decreased appetite.

• Fatigue, accompanied by dizziness or lightheadedness.

• Sleep disturbances and a general ill feeling.

In severe cases, such as high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE), symptoms may deteriorate, causing:

• Confusion or cognitive difficulties.

• Breathing challenges even at rest.

• Coordination and balance problems.

Prompt recognition of symptoms is crucial to prevent dangerous outcomes.

Diagnosis

Diagnosis of altitude sickness involves assessing your symptoms and conducting a physical exam. Symptoms like headaches, nausea, dizziness, and sleep issues typically arise within a day of arriving at a higher altitude. Your healthcare provider will evaluate these along with vital signs, such as breathing rate, blood pressure, and heart rate. Coordination assessments may be performed to rule out serious conditions requiring immediate attention, like high-altitude cerebral or pulmonary edema. While advanced diagnostics like MRIs or X-rays are available, they are not often needed, as improvement usually occurs upon descent.

Treatments

The primary approach to treating altitude sickness is to descend to a lower altitude quickly, which typically alleviates symptoms. For milder cases, resting and easing physical exertion help the body acclimate. Over-the-counter pain relievers, such as Ibuprofen, can manage headaches. If descending isn't feasible and symptoms are moderate, Acetazolamide can enhance breathing efficiency. In more severe situations, treatments might include Dexamethasone, nifedipine, as well as supplemental oxygen or a portable hyperbaric chamber. Severe symptoms demand immediate medical attention to prevent serious complications.

Medications

Several medications can aid in managing or preventing altitude sickness:

• Acetazolamide: Prescribed commonly to prevent altitude sickness; it enhances breathing efficiency and raises oxygen levels. Start taking it a day before climbing.

• Dexamethasone: Useful for moderate to severe cases, particularly to reduce brain swelling in emergencies.

• Nifedipine, Tadalafil, and Sildenafil: These help prevent high-altitude pulmonary edema (HAPE) by stabilizing breathing and preventing fluid buildup in the lungs.

Consult a healthcare provider for advice on dosage and potential side effects before using these medications.

Prevention

To prevent altitude sickness, consider these strategies:

• Ascend gradually, especially above 8,200 feet, with elevation increases of no more than 1,640 feet per day.

• Allow acclimatization by taking rest days, especially beyond 14,000 feet.

• Sleep at a lower altitude than the highest point reached during the day to reduce symptoms.

• Use medications like Acetazolamide to support acclimatization and prevent sickness.

• Avoid alcohol and intense exercise for the initial days at high altitudes to minimize stress on your body.