HIGH ALTITUDE

&
LOW ALTITUDE

PRESENTER : KHAIRAH KHALID

SUPERVISOR : DR ZAINAL ABIDIN OTHMAN
HIGH ALTITUDE

High altitude is a height above 3 000 metres (10 000 fts) above
sea level

• Atmospheric pressure (barometric pressure) falls as altitude increases

• But composition of air remains the same

• Oxygen : 20.98% Nitrogen : 78.06%

• Carbon Dioxide : 0.04% Inert gases : 0.92%

 DALTON’S LAW OF PARTIAL PRESSURE

TOTAL PRESSURE OF AIR = SUM OF PARTIAL PRESSURE

OF ALL GASES

P = po2 + pCO2 + pN2 + pH2O

• pH2o & pCO2 determined by body. So it does not change with altitude

• Only pO2 & pN2 change

 ALTITUDE CLASSIFICATION
ALTITUDE ELEVATION PRESSURE PRESSURE EFFECTS
(METERS) (mmHg) INSPIRED
OXYGEN
(PIO2)

SEA LEVEL 0 - 500 760-743 159-155 Normal

LOW 500 - 2 000 743-604 155-126 No effects
MODERATE 2 000 - 3 000 604-537 126-112 Usually none. No hypoxia
Safe of rapid ascent
HIGH 3 000—5 000 537-394 112-82 Moderate hypoxia with CVS &
Respiratory symptoms
EXTREME > 5 500 < 394 < 82 Severe hypoxia with CNS
HIGH symptoms
ACCLIMITIZATION
DEFINITION : Is a process in which an individual adjust to altitude
changes

• Body start to adjust at the height of 1 500m to 2 000 m

• The intensity depends on how high & how fast

• Various physiological readjustment & compensatory mechanism that

reduce the effect of hypoxia
PHYSIOLOGICAL EFFECT OF HIGH ALTITUDE
1. Effect of hypoxia

2. Effect of falls in atmospheric pressure

3. Effect of light rays

CLINICAL SYNDROMES CAUSED BY HIGH ALTITUDE

1. High Altitude Pulmonary Oedema (HAPO)

2. Acute Mountain Sickness

HYPOXIA
Hyperventilation
RESPIRATORY
-> stimulation of peripheral chemoreceptor cell in Carotid & Aortic Bodies ->
Increased rate & depth of breathing
CARDIO- Tachycardia
VASCULAR Increased cardiac contractility, cardiac output & blood pressure
Increased RBC production, increased erythropoietin level
CIRCULATORY Hematocrit rises & expansion of blood volume

-> due to decreased oxygen saturation in blood -> stimulate erythropoiesis

GIT Loss appetite, nausea, vomiting
Drowsy, headache -> altered behavior, lack or incoordination, slurred speech -
> twitching, convulsion & unconscious
CNS
-> hypoxia causing increased cerebral blood flow & vasodilatation -> further
decreased in cortical function
 EFFECT OF FALLS IN ATMOSPHERIC
TEMPERATURE
• The atmospheric temperature falls by 2’C for
every 1 000 ft/ 300 metres above sea levels

• EFFECTS :

Widespread cutaneous vasoconstriction

which may leads to tissue damage
(FROST-BITE)
 CLINICAL SYNDROME RELATED TO
HIGH ALTITUDE
1. ACUTE MOUNTAIN SICKNESS
• It refers to to symptoms complex occurring to

low-lander & first timer who ascend to very high

altitude for first 1-2 days

• The symptoms develop within 8-24 hours after

arrival to high altitude and last for 4-8 days

SYMPTOMS
1. GIT : Loss of appetite, nausea, vomiting
2. Respiratory : Breathlessness
3. CNS : Irritability, insomnia, headache,
High altitude cerebral edema (HACE)
4. Fatigue & weakness

TREATMENT
1. Do not proceed in a presence of symptoms
3 PRINCIPLES OF -> 2. Descend if symptoms worsen despite treatment
TREATMENT 3. Descend & treat immediately if there’s presence of altered
consciousness & pulmonary edema
TREATMENT
1. Oxygen therapy
2. Medical therapy

ACETAZOLAMIDE
• Mechanism : Carbonic anhydrase inhibitor, diuretics. It will excrete
H+ ion by the kidney. By excreting bicarbonate -> Blood become
more acidic -> Hyperventilation & increase oxygen in the blood

GLUCOCORTICOSTEROID
• To decrease cerebral edema
HIGH ALTITUDE PULMONARY EDEMA
• Most lethal of altitude illness
• Non cardiogenic pulmonary edema -> due to HYPOXIA

MECHANISM
1. Stimulation by hypoxia -> Vasoconstriction -> Increased pulmonary
capillary hydrostatic pressure -> Fluid out of pulmonary capillaries
2. Idiopathic non-inflammatory process -> Increase permeability of
pulmonary vascular endothelium -> Fluid leak as well
CLINICAL FEATURES
1. Early symptoms
• Fatigue, weakness, dyspnea – Worsen at night
• Tachycardic, tachypnic
2. Cough, frothy sputum, cynosis, rales. Up to severe respiratory distress
3. In severe cases -> Altered mental status, hypotension

TREATMENT
1. Descend to lower altitude
2. Rest
3. Oxygen therapy – Portable hyperbaric chamber
4. Medical therapy
• Nifedipine : Calcium channel blocker.
Mechanism : Vasodilator. Can reduce pulmonary arterial pressure & pulmonary
resistance -> thus improved oxygenation
 LOW ALTITUDE
• Atmospheric pressure of 760 mmHg at sea level = 1 atmospheric
pressure

• Thus for every descend 33 ft / 10 meters will increase by 1 atmospheric

pressure

• Examples:
1. Deep sea diving

2. Submarines
PHYSIOLOGICAL OF HIGH PRESSURE
1. INCREASED pO2 -> Acute oxygen toxicity
2. INCREASED pN2 (NITROGEN NARCOSIS)
• 3. INCREASED CARBON DIOXIDE
DECOMPRESSION SICKNESS
• Or known as Dysbarism/ Divers Palsy

• Caused by high pressure of nitrogen in the breathed air ->

Dissolved in body fluids & fats

• Mechanism
- When a diver ascend rapidly to sea level -> Nitrogen is decompressed
& escapes from the tissue in the form of bubbles.
- Thus, these bubbles block the blood vessels -> ischemia & infarction
CLINICAL FEATURES

1. General : Fatigue, weakness

2. Musculoskeletal : Joint & muscle pain
3. CNS : Numbness, tingling, paralysis, headache, dizziness,
vertigo
4. Pulmonary : Dyspnea & cough
5. Skin : Itchiness

TREATMENT

1. Tank decompression – Hyperbaric chamber