Respiratory Changes on High

Altitude
• High altitude  effect on human body
• To attain homeostasis
• Maintain oxygen supply to cellular
respiration
• Altitude is defined on the following scale High
(2,438 - 3,658 meters), Very High 3,658 - 5,487
meters), and Extremely High (5,500 or more
meters)
• As altitude increases, the concentration remains
the same but the number of oxygen molecules per
breath is reduced. At 12,000 feet (3,658 meters)
the barometric pressure is only 483 mmHg
• Dalton’s law
– The partial pressure of a gas can be calculated from
its fractional concentration
ALTITUDE
 Immediate Responses to Altitude

• Arrival at higher initiates rapid physiologic

adjustments to compensate for the thinner air
and accompanying reduction in alveolar PO2
• Important responses:
– Increases in the respiratory drive to produce
hyperventilation
– Increase in blood flow during rest and
submaximal exercise
 Oxygen loading at altitude
• The oxyhemoglobin dissociation curve is S-
shaped and only a small change occurs in
hemoglobin’s percentage saturation with
oxygen until an altitude of about 3048 m.
• At 1981 m, alveolar PO2 decreases from its
sea level value of 100 mm Hg to 78 mmHg,
yet Hb remains 90% saturated with oxygen
 Acclimatization to Low PO2
• Increased pulmonary ventilation
• Increased numbers of red blood cells
• Increased diffusing capacity
• Increased vascularization of peripheral
tissue
• Increased oxygen utilization by cells
ACUTE EFFECT OF HYPOXIA
• Drowsiness, lassitude, fatigue, headache,
nausea, euphoria
• Seizures
• Coma
• Death
 Hyperventilation
• Hyperventilation from reduced arterial PO2
is the most important and clear-cut
immediate response of the native lowlander
to altitude exposure
• Once initiated, this “Hypoxic Drive”
increases during the first few weeks and can
remain elevated for a year or longer during
prolonged altitude residence
 Identification and Treatment of
Altitude-Related Medical Problems
• Native who live and work at high altitudes
as well as new comers risk a variety of
medical problems associated with reduced
arterial PO2.
• These problems usually remain mild and
dissipate within several days, depending on
the rapidity of the ascent and degree of
exposure
• Three medical conditions threaten those who
ascend to high altitude:
– Acute mountain sickness (AMS), the most
common malady
– High-altitude pulmonary edema (HAPE), which
reverses if the person returns quickly to a lower
altitude
– High-altitude cerebral edema (HACE), a
potentially fatal condition if not diagnosed and
treated immediately
Acute mountain sickness (AMS)
• Most people experience the discomfort of AMS
during the first few days at altitudes of 2500 m
and above
• Can exacerbated by exercise in the first few hours
of exposure
• Possibly results from acute reduction in cerebral
oxygen saturation
• It occurs most frequently in those who ascend
rapidly to a high altitude without benefiting from
gradual and progressive acclimatization to lower
altitudes
Acute mountain sickness (AMS)
• Symptoms usually begin within 4 to 12
hours and dissipate within the first week
• Headache, the most frequent symptom,
probably results from increased cerebral
hemodynamics from short Hyperventilation
CONDITION
Acute Mountain Sickness (AMS)
High-altitude pulmonary edema (HAPE)
High-altitude cerebral edema (HACE)
SYMPTOMS
Severe headache, fatigue, irritability, nausea,
vomiting, loss of appetite, indigestion,
flatulence, generalized weakness,
constipation, decreased urine output with
normal hydration, sleep disturbances
Debilitating headache and severe fatigue,
excessively rapid breathing and heart rate,
rales, cough producing pink frothy sputum,
bluish skin colour (from low blood PO2);
disruption of vision, bladder, and bowel
function, poor reflexes, loss of coordination of
trunk muscles, paralysis on one side of the
body
Staggered gait, dyspnea upon exertion, severe
weakness/fatigue, persistent cough with
pulmonary infection, pain or pressure in
substernal area, confusion, impaired mental
processing, drowsiness, ashen skin color, loss
of consciousness
Acute mountain sickness (AMS)
• Decreased thirst sensation and severe
appetite suppression can occur during the
early stages, often resulting in a 40%
reduction in energy intake and consequent
body mass loss
 High-altitude Pulmonary Edema
(HAPE)
• For unknown reasons, about 2% of
sojourners to altitudes above 3000 m
experience HAPE
• Symptoms usually manifest within 12-96
hours following rapid ascent
• At first, symptoms do not seem severe, but
the syndrome progresses to pulmonary
edema and fluid retention by the kidneys
 Prevention and treatment of HAPE
• Prevention
– Slow ascent for susceptible individuals (average increase
in sleeping altitude of 300-350 m)
– No ascent to higher altitude with symptoms of AMS
– Descent when AMS symptoms do not improve after a day
of rest
– Under circumstances of high risk: avoid vigorous exercise
when not acclimatized
– Nifedipine : 20 mg slow0release formulation every 6 hours
(or 30-60 mg sustained-release formulation once daily) for
susceptible individuals when slow ascent is impossible
 Prevention and treatment of HAPE
• Treatment
– Descent by at least 1000 m (primary choice in
mountaineering)
– Supplemental oxygen: 2-4 L/mnt (primary choice
in areas with medical facilities)
– When 1 and/or 2 not possible:
• Administer 20 mg nifedipine slow-release formulation
every 6 hours
• Use portable hyperbaric chamber
• Descent to low altitude as soon as possible
 High-altitude Cerebral Edema
• HACE is a potentially fatal neurologic
syndrome that develops within hours or
days in individuals with AMS
• HACE occurs in about 1% of people
exposed to altitudes above 2700 m, it
involves increased intracranial pressure that
causes coma and death if left untreated