What is Altitude Sickness?
Altitude sickness is the term for a collection of symptoms that affect people who spend time at high elevations without first becoming accustomed to the low-oxygen environment. The disorder is also sometimes called mountain sickness or high-altitude sickness.
The symptoms of altitude sickness occur the oxygen content in the air at high altitudes is relatively less than it is at low altitudes. The lack of oxygen puts stress on the body and causes a variety of symptoms. It is possible for a person to become accustomed to the low-oxygen environment by climbing slowly and spending an adequate amount of time at each level before climbing higher. Altitude sickness happens when you climb too high too fast.
Altitude sickness can be relatively mild, or it can be severe and life-threatening. The term is generally applied to three different disorders with varying degrees of severity:
- Acute mountain sickness (AMS) is the least severe form of the disorder. It typically sets in after 12-24 hours at high altitude. Symptoms usually resolve within 1-2 days at altitude as the body adjusts to the environment.
- High-altitude cerebral edema (HACE) is swelling of the brain caused by an accumulation of fluid. It usually occurs after the symptoms of AMS. If not treated immediately, HACE can be fatal.
- High-altitude pulmonary edema (HAPE) is an accumulation of fluid in the lungs. It can occur in conjunction with AMS and/or HACE, but HAPE can also occur on its own. Without treatment, HAPE can also be life-threatening.
Symptoms of Acute Mountain Sickness
Symptoms of AMS include:
- Shortness of breath
- Nausea and/or vomiting
- Loss of appetite
Symptoms of High-Altitude Cerebral Edema
HACE affects the sufferer’s thought processes, so symptoms might only be noticed by others around them.
Symptoms of HACE include:
- Extreme headache
- Difficulty walking in a straight line
- Extreme fatigue
- Difficulty concentrating or forming thoughts
- Changes in behavior (sometimes irrational)
If left untreated, HACE can quickly cause coma or death.
Symptoms of High-Altitude Pulmonary Edema
The symptoms of HAPE may follow the symptoms of AMS, or they may occur when there have been no prior symptoms.
Symptoms of HAPE include:
- Tightness in the chest
- Shortness of breath even without exertion
- Rapid heart rate
- Blue or gray tint to the lips and/or fingernails
- Wheezing, rattling, or gurgling breath sounds
- Cough, sometimes producing a pink foamy liquid
Symptoms can be severe and may linger for weeks, even with treatment.
What Causes Altitude Sickness?
AMS, HACE, and HAPE occur as the body tries to adjust to suddenly decreased access to oxygen. The body’s initial reaction to the oxygen deficit is to increase its breathing and heart rates to take in as much oxygen as possible and transport that oxygen more effectively around the body. As the oxygen deprivation continues, the body responds by making changes to its circulatory system and other processes in an attempt to protect vital organs and functions.
The body’s rapid adjustments to the new environment put stresses on many organs and tissues, resulting in the symptoms of AMS. As the brain and lungs contend with changes in circulatory function, the normal flow of fluid in their tissues is disrupted, and fluid may accumulate abnormally in the organs, causing HACE and HAPE.
Is Altitude Sickness Hereditary?
Scientists are currently unsure about the heritability of altitude sickness. Some people are more susceptible than others to altitude sickness, leading some scientists to suspect that there is an inherited component that increases the risk for the disorders. Studies have attempted to find specific genetic traits that are associated with AMS, HACE, and HAPE.
Recent studies have been unable to find a genetic link to either AMS or HACE. The studies’ results have been inconclusive, partly because AMS symptoms are difficult to measure objectively and HACE is relatively very rare.
Studies have been able to identify gene variations that appear to increase an individual’s risk of developing HAPE and some other altitude-related disorders.
How Is Altitude Sickness Detected?
The first symptoms of AMS are commonly rapid breathing, rapid heart rate, and headache. These symptoms may not be dangerous on their own, but in rare cases, AMS can progress to HACE and/or HAPE, so even mild symptoms shouldn’t be ignored.
HACE progresses rapidly and can only be stopped with a shift, decisive intervention. The symptoms often begin overnight while the sufferer is sleeping, and because HACE adversely affects thought processes, the sufferer might not recognize the symptoms on their own. It is often up to the people around the sufferer to identify the symptoms and take action.
Early signs of HACE include:
- Difficulty walking in a straight line
- Changes in behavior
The first sign of HAPE is often extreme fatigue, but other early symptoms may include a dry cough, rapid heart rate, and rapid breathing.
How Is Altitude Sickness Diagnosed?
AMS can be diagnosed if the patient has a headache and at least one other symptom within 1-2 days of climbing to a high altitude.
HACE should be suspected when someone at high altitude shows symptoms such as behavior changes, hallucinations, or difficulty walking in a straight line. Magnetic resonance imaging (MRI) scans can detect brain swelling consistent with HACE.
If a doctor suspects HAPE, they will use a stethoscope to listen for a crackling sound in the patient’s chest. X-rays may be required to confirm the accumulation of fluid in the lungs.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Altitude Sickness Treated?
Mild cases of AMS can be treated by resting and not moving any higher in elevation. In cases of more severe symptoms, or if any symptoms of HACE or HAPE are present, moving to a lower altitude is the first step in treatment.
The medication acetazolamide may also be recommended to treat AMS symptoms. This drug stimulates breathing and helps the body counter the effects of oxygen deprivation.
Treatment for HACE typically includes:
- Moving to a lower altitude as quickly and safely as possible
- Administration of supplemental oxygen
- Administration of the steroid dexamethasone to reduce brain swelling
- Use of a hyperbaric chamber, a high-pressure environment that delivers oxygen more effectively to the patient
Treatment of HAPE can include:
- Movement to a lower altitude
- Supplemental oxygen
- Medications to regulate blood flow to the lungs
- Hyperbaric therapy
- Use of a mechanical respirator in severe cases
How Does Altitude Sickness Progress?
HACE is the most immediately life-threatening type of altitude sickness, and without immediate treatment, the brain swelling can quickly result in severe complications and death. Complications of severe, untreated HACE can include:
- Permanent cognitive impairment
- Vision disruption
How Is Altitude Sickness Prevented?
Most of the time, altitude sickness can be prevented by following recommended climbing practices. It’s important to remember that altitude sickness does not only affect mountain climbers. It can affect anyone who spends time at a high altitude without first becoming accustomed to the change in elevation.
To reduce your risk of developing altitude sickness:
- Move slowly to a high altitude if possible. Do not drive or fly directly to a high elevation without stopping.
- Do not exert yourself physically for the first few days after moving to a higher elevation.
- Drink plenty of water as you move up in elevation.
- Do not climb more than 1,000 feet per day when climbing above 10,000 feet.
- Spend an extra night each time you ascend 3,000 feet.
- Move to a lower altitude whenever you feel symptoms of altitude sickness.
Altitude Sickness Caregiver Tips
If you’re spending time at high altitude with other people, you may be responsible for keeping your companions safe and healthy.
- Know the symptoms of altitude sickness. Educate yourself so that you can spot the early signs of altitude-related illnesses. Learn how to tell the difference between common symptoms of minor acute mountain sickness and the more serious signs of cerebral and pulmonary edemas.
- Be prepared to act quickly. Whenever you’re at high altitude, have a plan for what you’ll do if you or your companions begin to suffer from altitude sickness. Know the safest, quickest way to move to a lower altitude. Don’t hesitate to descend and seek medical help at the first signs of severe altitude sickness.
Altitude Sickness Brain Science
Scientists are working to understand how high-altitude cerebral edema (HACE) develops and how this severe condition is related to less severe acute mountain sickness (AMS). Specifically, researchers want to know precisely what causes fluid accumulation in the brain and whether the accumulation is directly related to the early symptoms of AMS.
Cerebral edema is generally caused either by the accumulation of fluid within the brain cells themselves or by the leakage of water and proteins from blood vessels into the brain. Recent studies have suggested that HACE is likely caused by fluid that leaks from blood vessels, although it’s not clear how that fluid passes through the barrier that usually keeps contaminants from entering the brain. It’s possible, too, that after fluid accumulates from that source, additional fluid might accumulate within the cells as well.
Another question is whether the headaches characteristic of early AMS are related to brain swelling. Recent studies have shown that the brain tends to swell at high altitudes. Some research suggests that people who have relatively little space inside their skulls to accommodate that swelling might be more susceptible to AMS.
Altitude Sickness Research
Title: Breathing Training to Improve Human Performance at High Altitude
Contact: Robert Roach, PhD
Altitude Research Center
Individuals traveling to altitudes above 8,000 feet may suffer from impaired exercise and cognitive performance, and acute mountain sickness (AMS). Decreased barometric pressure, which leads to low blood oxygen levels, is the primary cause of these disorders. Symptoms of AMS are characterized by headache, nausea, vomiting, dizziness, fatigue, and difficulty sleeping. The goal of this research is to identify whether Respiratory Muscle Training will improve physical and cognitive performance, and reduce the symptoms of AMS, at simulated high altitude.
Title: High Altitude and Exogenous Carbohydrate Oxidation
Principal investigator: Lee M Margolis, PhD
United States Army Research Institute of Environmental Medicine
This randomized crossover study will examine substrate metabolic responses to ingesting supplemental carbohydrate during steady-state aerobic-type exercise at sea level (SL) and following acute (~5 h) exposure to HA (4,300 m) conditions in 10 healthy, recreationally active adults between the ages of 18-39 yrs. Following a 48-hr muscle glycogen normalization period, volunteers will complete 80-min of metabolically-matched, steady-state aerobic exercise on a treadmill, and consume 145 g of glucose (1.8 g·min-1) at SL and HA. Treadmill exercise will be performed at the same absolute workload, with speed and grade being the same at SL and HA to induce the same absolute workload between phases. SL and HA trials will occur in the US Army Research Institute of Environmental Medicine (USARIEM) hypobaric chamber and will be separated by a minimum 7-d washout period between each protocol day. 6-6-[2H2] glucose will be used as a tracer to assess glucose turnover. Indirect calorimetry, breath sampling for 13C/12C expired in CO2, and urine collections will be used to determine carbohydrate, fat, and protein oxidation during exercise at SL and HA. Serial blood draws will be collected during each trial to assess endocrine and circulating substrate responses to exercise, carbohydrate, and hypoxia. Muscle biopsies will be collected before and after steady-state exercise to examine intramuscular glucose transport expression and translocation, glycogen status, and activity enzyme intermediates in aerobic and anaerobic energy metabolism.
Title: Physiological Adaptations to Simulated Intermittent Altitude on Human Health and Performance
Principal investigator: Courtney Wheatley-Guy, PhD
Mayo Clinic in Arizona
The investigators expect to find that different intensity and altitude exposure levels will show what kind of intermittent exposure protocol is more beneficial to athletes and healthy individuals that experience acute exposure to altitude during exercise. This may furthermore be related to acute altitude exposure for recreational exercise use as well.