Altitude is defined on the following scale High (8,000 - 12,000 feet [2,438 - 3,658
meters]), Very High (12,000 - 18,000 feet [3,658 - 5,487 meters]), and Extremely High
(18,000+ feet [5,500+ meters]). As altitude increases, the total pressure and partial
pressure of oxygen decreases, resulting in hypoxia which may be associated with
decreased exercise performance, increased ventilation, and symptoms of lightheadedness,
fatigue, altered perceptions, and sleep disorders. Although the risk increases with altitude,
some susceptible individuals may experience symptoms of altitude-related illness
beginning as low as 2,500 m. The barometric pressure at 5,500 m is one-half of that at sea
level. In addition, the temperature drops an average of 6.5o C per 1,000 m of elevation
and penetration of ultraviolet (UV) light increases about 4% per 300 m gain in altitude.
The combination of cold and hypoxia enhances the risk of cold injuries and
altitude problems. The extra UV penetration increases the risk of sunburn, skin cancer,
and snow-blindness. Furthermore, in the absence of wind, the reflection of sunlight on
flat glaciers can lead to intense radiation with a paradoxical temperature elevation of up
to 40o C. Heat exhaustion or dehydration may thus go unrecognized.
The major cause of altitude illnesses is going too high too fast. Given time, your body
can adapt to the decrease in oxygen molecules at a specific altitude. This process is
known as acclimatization and generally takes 1-3 days at that altitude. For example, if
you hike to 10,000 feet (3,048 meters), and spend several days at that altitude, your body
acclimatizes to 10,000 feet (3,048 meters). If you climb to 12,000 feet (3,658 meters),
your body has to acclimatize once again. A number of changes take place in the body to
allow it to operate with decreased oxygen.
Acute profound hypoxia may occur during rapid ascent, or when there is an
abrupt decline in oxygenation. The latter may be due to overexertion, carbon monoxide
poisoning, pulmonary edema, sleep apnea, or failure of the system used to deliver
oxygen. Symptoms include fatigue, weakened sensory perceptions, vertigo, sleepiness,
hallucinations, and ringing in the ears. The ultimate consequence of acute hypoxia is loss
of consciousness, which occurs in the non-acclimatized person at an arterial oxygen
saturation (SaO2) of 40% to 60% or an arterial PO2 of < 30 mm Hg.
Many people will experience mild AMS during the acclimatization process. Symptoms
usually start 12-24 hours after arrival at altitude and begin to decrease in severity about
the third day. Symptoms tend to be worse at night and when respiratory drive is
decreased. Mild AMS does not interfere with normal activity and symptoms generally
subside within 2-4 days as the body acclimatizes. As long as symptoms are mild, and only
a nuisance, ascent can continue at a moderate rate. When hiking, it is essential that you
communicate any symptoms of illness immediately to others on your trip. AMS is
considered to be a neurological problem caused by changes in the central nervous system.
It is basically a mild form of High Altitude Cerebral Edema.
HACE is the result of swelling of brain tissue from fluid leakage. Symptoms can
include headache, loss of coordination (ataxia), weakness, and decreasing levels of
consciousness including, disorientation, loss of memory, hallucinations, psychotic
behavior, and coma. It generally occurs after a week or more at high altitude. Severe
instances can lead to death if not treated quickly.Im m ediate descent is a necessary life-
saving measure (2,000 - 4,000 feet [610-1,220 meters]). There are some medications that
may be prescribed for treatment in the field, but these require that you have proper
training in their use. Anyone suffering from HACEm ust be evacuated to a medical
facility for proper follow-up treatment.
HAPE results from fluid buildup in the lungs. The fluid in the lungs prevents
effective oxygen exchange. As the condition becomes more severe, the level of oxygen in
the bloodstream decreases, and this can lead to cyanosis, impaired cerebral function, and
death. Symptoms include shortness of breath even at rest, "tightness in the chest," marked
fatigue, a feeling of impending suffocation at night, weakness, and a persistent productive
cough bringing up white, watery, or frothy fluid. Confusion, and irrational behavior are
signs that insufficient oxygen is reaching the brain. One of the methods for testing
yourself for HAPE is to check your recovery time after exertion. If your heart and
breathing rates normally slow down in X seconds after exercise, but at altitude your
recovery time is much greater, it may mean fluid is building up in the lungs. In cases of
HAPE,im mediate descent is a necessary life-saving measure (2,000 - 4,000 feet [610-
1,220 meters]). Anyone suffering from HAPEm ust be evacuated to a medical facility for
proper follow-up treatment.
Retinal hemorrhages are very common > 5,200 m. These are not necessarily
related to AMS and are more related to hypoxemia. They are symptomatic only if found
over the macula. While retinal haemorrhages may lead to blindness, the majority resolve
on descent within 7 to 14 days. Although there is no evidence that the location of a
hemorrhage will be the same on repeat ascent to high altitude, most experts would
consider this to be a contraindication for future ascents. Hemorrhages not affecting vision
are not known to have any clinical significance and do not warrant descent. Hemorrhages
have been induced by strenuous exercise which increases blood pressure and decreases
the arterial oxygen saturation levels. Below 5200 m, hemorrhages are more likely due to
high-altitude illnesses and these should be managed according to the syndrome involved.
Normal sleep is often impaired at high altitudes. At about 3,048 m, some
individuals will report poor sleep while the majority of persons sleeping > 4,300 m have
marked sleep disturbance. In a study of six men during 2 nights at sea level and four non
consecutive nights at 4,301 m at the high altitude, all had disturbed sleep as measured by
sleep electroencephalogram. This was characterized by a significant decrease in sleep
stages three and four, and a trend toward more time spent awake. The men complained of
poor sleep but there was only a small reduction in total sleep time. Five also had periodic
breathing, but arousals from sleep were not always associated with this breathing pattern.
The mechanism of arousal is not certain, but may be related to hypoxia.
Periodic breathing occurs mainly at night, and is characterized by hyperpnea
followed by apnea. Persons with a high hypoxic ventilatory response (HVR) have higher
rates of periodic breathing, while persons with low HVR may have periods of extreme
hypoxemia during sleep that are unrelated to periodic breathing. There is evidence that
arousal is protective in preventing severe oxygen deprivation.
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