INTRODUCTION

Altitude sickness / Mountain sickness, the

mildest form being acute mountain
sickness (AMS), is the negative health effect of
high altitude (>2500m), caused by rapid
exposure to low amounts of oxygen at high
elevation.

In a simple way, it is a group of symptoms that

can strike if you walk or climb to a higher
elevation, or altitude, too quickly.

(Roach et al., 2018)

INTRODUCTION
• The pressure of the air that surrounds you is
Why it happens ? called barometric pressure.
• When you go to higher altitudes, this
pressure drops and there is less oxygen
available.
• If you live in a place that’s located at a
moderately high altitude, you get used to the
air pressure.
• But if you travel to a place at a higher
altitude than you’re used to, your body will
need time to adjust to the change in pressure.
• Any time you go above 8,000 feet, you can
be at risk for altitude sickness.
INTRODUCTION
Signs & Symtoms
• Headache
• Dizziness
• Nausea
• Vomiting
• Fatigue and loss of energy
• Shortness of breath
• Problems with sleep
• Loss of appetite
INTRODUCTION
Types of mountain sickness
1. Acute Mountain Sickness (AMS) is the mildest form and it’s very
common. The symptoms can feel like a hangover, dizziness,
headache, muscle aches and nausea.

2. High Altitude Pulmonary Edema (HAPE) is a buildup of fluid in

the lungs that can be very dangerous and even life threatening.

3. High Altitude Cerebral Edema (HACE) is the most severe form of

altitude sickness and happens when there’s fluid in the brain. It’s life
threatening and you need to seek medical attention right away.
(Hackett, 1976)
INTRODUCTION
Risk factors
Have a prior history of high altitude illness.
Overexert themselves or drink alcohol before adjusting to the change
in altitude.
Ascend rapidly from low elevation to sleeping altitudes above 8000
feet (2400 m).
Ascend rapidly (>500 to 1000 m /day in sleeping altitude), when over
9000 feet (2700 m).
Have a medical problem that affects breathing.
Have not been to altitude in the previous few weeks.
(Jin, 2017)
PATHOPHYSIOLOGY
Barometric pressure falls with increasing altitude and consequently
there is a reduction in the partial pressure of oxygen resulting in a
hypoxic challenge to any individual ascending to altitude.
A spectrum of high altitude illnesses can occur when the hypoxic
stress outstrips the subject's ability to acclimatize.
Cerebral edema is consistently found in neuroimaging and at autopsy
in patients with severe AMS or HACE.
MRI studies reveal reversible vasogenic brain edema, with
characteristic T2 signal increase in the splenium of the corpus
callosum and subcortical white matter.
These findings indicate increased blood-brain barrier (BBB)
permeability.
PATHOPHYSIOLOGY
Some hypotheses to explain this increased cerebral vascular
permeability emphasize the role of increased intravascular pressure.
Increased cerebral blood flow and the loss of auto-regulation of
intracranial pressure may contribute to such an increase.
Chemical factors (eg, vascular endothelial growth factor, nitric oxide,
cytokines) may also play a role by altering endothelial permeability.

(Imray et al., 2010; Bailey et al., 2009; West, 2004)

PARAMEDICAL TREATMENT
Descend to Lower Altitude
• For mild acute mountain sickness, the person may be able to stay at
current altitude to see if his or her body adjusts.
• If symptoms don’t get better in 24 to 48 hours or if they get worse,
the person should go down to a lower altitude and seek immediate
medical care.
• For severe symptoms, the person should immediately be taken down
1,500 to 2,000 feet with as little exertion as possible.
• Keep going down until symptoms go away. Get medical help right
away as waiting could cause serious problems or even death.
PARAMEDICAL TREATMENT
• Even if symptoms are mild, the person should not go any higher in
altitude until symptoms are completely gone.

Treat Symptoms
• Give oxygen, if available.
• Keep the person warm and have him or her rest.
• Give plenty of liquids.
• Give acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
for headache.
• Avoid alcohol and sleeping medications.
PARAMEDICAL TREATMENT
See a Health Care Provider
• If mild symptoms persist after descent, call a healthcare provider.
• For severe symptoms, the person should see a doctor as soon as
possible, even if symptoms go away after descent.
(Mallinson& Eaton, 2013; Kapoor et al., 2004)
 REFERENCES
• Roach, R. C., Hackett, P. H., Oelz, O., Bärtsch, P., Luks, A. M., MacInnis, M. J.
and Andrews, J. S. (2018). The 2018 Lake Louise Acute Mountain Sickness
Score. High Altitude Medicine & Biology, 19(1), 4–6.
• Hackett, p. (1976). The incidence, importance, and prophylaxis of acute
mountain sickness. The Lancet, 308(7996), 1149–1155.
• Bailey, D.M., Bärtsch, P., Knauth, M. and Baumgartner RW. (2009).
Emerging concepts in acute mountain sickness and high-altitude cerebral
edema: from the molecular to the morphological. Cell Mol Life, 66:3583.
• West, J.B. (2004). American College of Physicians, American Physiological
Society. The physiologic basis of high-altitude diseases. Ann Intern Med,
141:789.
 REFERENCES
• Imray, C., Wright, A., Subudhi, A., & Roach, R. (2010). Acute Mountain
Sickness: Pathophysiology, Prevention, and Treatment. Progress in
Cardiovascular Diseases, 52(6), 467–484. 
• Kapoor, R., Narula, A., & Anand, A. (2004). Treatment of Acute Mountain
Sickness and High Altitude Pulmonary Oedema. Medical Journal Armed
Forces India, 60(4), 384–387.
• Mallinson, T., & Eaton, G. (2013). Prevention, assessment and management
of altitude sickness. International Paramedic Practice, 3(4), 86–91.
• Jin, J. (2017). Acute Mountain Sickness. JAMA, 318(18), 1840.