Mountains cover one-fifth of the earth’s surface; 140 million people
live permanently at altitudes ≥2500 m, and 100 million people travel to
high-altitude locations each year
Skiers in the Alps ; tourists to La Paz, Ladakh, or Lahsa; religious pilgrims to Kailash-Manasarovar or Gosainkunda; trekkers and climbers to Kilimanjaro, Aconcagua, or
Everest; miners working in high-altitude sites in South America; and
military personnel deployed to high-altitude locations are all at risk
of developing acute mountain sickness (AMS), high-altitude cerebral
edema (HACE), high-altitude pulmonary edema (HAPE), and other
altitude-related problems.
The most important risk factors for the development
of altitude illness are the rate of ascent and a prior history of high altitude
illness.
ACUTE MOUNTAIN SICKNESS
+Exertion is a risk factor, but lack of physical fitness is
not.
+Children and adults seem to be equally affected, but people >50 years of age may be
less likely to develop AMS than younger people.
HIGH ALTITUDE PROBLEMS
-Sleep Impairment due to high altitude
The mechanisms underlying sleep problems,
which are among the most common adverse reactions to high altitude,
include increased periodic breathing; changes in sleep architecture,
with increased time in lighter sleep stages; and changes in rapid eye
movement sleep.
-Gastrointestinal Issues
High-altitude exposure may be associated
with increased gastric and duodenal bleeding.
-High-Altitude Cough
high-altitude cough has been attributed to inspiration
of cold dry air. Exercise can precipitate cough at high altitudes,
possibly because of water loss from the respiratory tract.
-Psychological/Psychiatric Problems
Delirium characterized by a sudden change in mental status, a short attention span, disorganized thinking, and an agitated state during the period of confusion
has been well described in mountain climbers and trekkers without a
prior history.
Prevention and Treatment of altitude sickness
-Gradual ascent, with adequate time for acclimatization, is the best method for the prevention of altitude illness.
-Spending one night at an intermediate altitude before proceeding to a higher altitude may enhance acclimatization and attenuate the risk of AMS.
-Proper hydration (but not overhydration) in high-altitude trekking and climbing, aimed at countering fluid loss due to hyperventilation and sweating, may play a role in avoiding AMS.
- treatment with acetazolamide and Use of low-flow oxygen.
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