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Medicine and Mechanisms in Altitude Sickness

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Summary

Acute mountain sickness (AMS) has long been recognised as a potentially life-threatening condition afflicting otherwise healthy normal individuals who ascend rapidly to high altitude where the partial pressure of oxygen (pO2) in the air is reduced. The symptoms of AMS (e.g. headache, poor appetite and nausea, fatigue and weakness, dizziness or light-headedness and poor sleep) are probably a consequence of disturbances in fluid balance brought about by severe tissue hypoxia. AMS can be prevented by an adequately slow ascent, which is the best method, but for those with limited time there are several drug therapies that provide a relatively good protection. Acetazolamide (250mg twice daily or 500mg slow release once daily), taken before and during, ascent is probably the treatment of choice; it improves gas exchange and exercise performance and reduces the symptoms of AMS in most individuals. Dexamethasone (4mg, 4 times daily) is more of value for short term treatment or prevention, and should never be used for more than 2 to 3 days. Prophylactic use of progesterone looks promising, but more studies are required.

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References

  1. Gerard A. Account of Koonawar. Lloyd, editor. In: Ward M. Mountain mdicine. London: Crosby Lockwood Staples, 1975

    Google Scholar 

  2. Whymper E. Travels amongst the great Andes of the equator. London: Thomas Nelson and Sons, 1892

    Book  Google Scholar 

  3. Mosso A. Life of a man on the high alps. London: Fisher Unwin, 1898

    Google Scholar 

  4. Engel CE. Mountaineering in the Alps. London: George Allen and Unwin Limited, 1971

    Google Scholar 

  5. Benuzzi F. No picnic on Mt Kenya. London: W Kimber & Co. Limited, 1952

    Google Scholar 

  6. Sutton JR, Coates G, Houston CS, editors. Hypoxia and mountain medicine. Proceedings of the 7th International Hypoxia Symposium; Feb 1992: Lake Louise, Canada. Advances in the Biosciences. Vol. 84. Oxford: Pergamon Press, 1993

  7. Frayser R, Houston CS, Bryan AC, et al. Retinal haemorrhage at high altitude. N Engl J Med 1970; 282: 1183–4

    Article  PubMed  CAS  Google Scholar 

  8. Rennie D, Morrisey J. Retinal changes in Himalayan climbers. Archives Ophtalmol 1975; 93: 395–400

    Article  CAS  Google Scholar 

  9. Clarke C, Duff J. Mountain sickness, retinal haemorrhage and acclimatisation on Mount Everest in 1975. BMJ 1976; 2: 495–7

    Article  PubMed  CAS  Google Scholar 

  10. Nakashima M. High altitude medical research in Japan. Jpn J Mountain Med 1983; 3: 23–7

    Google Scholar 

  11. Winterborn MH, Bradwell AR, Chesner I, et al. Mechanisms of proteinuria at high altitude. Clin Sci 1986; 70: 58P

    Google Scholar 

  12. Hackett PH, Rennie D. Rales, peripheral edema, retinal haemorrhage and acute mountain sickness. Am J Physiol 1979; 67: 214–8

    CAS  Google Scholar 

  13. Heath D, Williams DR. High altitude medicine and pathology. London: Butterworths, 1989

    Google Scholar 

  14. Winslow RM, Monge CC. Hypoxia, polycythemia and chronic mountain sickness. London: John Hopkins University Press, 1987

    Google Scholar 

  15. Monge MC. Life in the Andes and chronic mountain sickness. Science 1942; 95: 79–84

    Article  PubMed  CAS  Google Scholar 

  16. Kryger M, McCullough RE, Collins D, et al. Treatment of excessive polycythemia of high altitude with respiratory stimulant drugs. Am Rev Respir Dis 1978; 117: 455–64

    PubMed  CAS  Google Scholar 

  17. Coote JH. Pharmacological control of acute mountain sickness. Trends Pharmacol Sci 1991; 12: 450–5

    Article  PubMed  CAS  Google Scholar 

  18. Severinghaus JS, Mitchell RA, Richardson BW, et al. Respiratory control at high altitude suggesting active transport regulation of CSFpH. Journal of Applied Physiology 1963; 18: 1155–66

    PubMed  CAS  Google Scholar 

  19. Lahiri S, Milledge JS. Acid-base in Sherpa altitude residents and lowlanders at 4880m. Respir Physiol 1967; 2: 323–34

    Article  PubMed  CAS  Google Scholar 

  20. Milledge JS. Acid-base changes associated with respiratory acclimatisation to altitude. Postgrad Med J 1979; 55: 459–63

    Article  Google Scholar 

  21. Ward MP, Milledge JS, West JB. High altitude medicine and physiology. London: Chapman and Hall Medical, 1989

    Google Scholar 

  22. Fencl V, Miller TB, Pappenheimer JR. Studies on the respiratory response to disturbances of acid-base balance with deductions concerning ionic composition of central interstitial fluid. Am J Physiol 1966; 210: 459–72

    PubMed  CAS  Google Scholar 

  23. Bledsoe SW, Hornbein TF. Central chemosensors and the regulation of their chemical environment. In: Hornbein TF, editor. Regulation of breathing (Pt 1). New York: Marcel Dekker Inc, 347–428: 1981

    Google Scholar 

  24. Birmingham Medical Research Expeditionary Society. Acetazolamide in control of acute mountain sickness. Lancet 1981; 1: 180–3

    Google Scholar 

  25. Hunter DJ, Smart J R, Whitton L. Increased capillary fragility at high altitude. Br J Med 1986; 292: 98

    Article  CAS  Google Scholar 

  26. Winterborn MH, Bradwell AR, Chesner IM, Jones GT. The origin of proteinuria at high altitude. Postgrad Med J 1987; 63: 179–81

    Article  PubMed  CAS  Google Scholar 

  27. Bartsch P, Maggiorini M, Schobersberger W, et al. Enhanced exercise-induced rise of aldosterone and vasopressin preceding mountain sickness. J Appl Physiol 71: 136–143, 1991

    PubMed  CAS  Google Scholar 

  28. Bartsch P, Shaw S, Weidmann P, et al. Aldosterone, antidiuretic hormone and atrial natriuretic peptide in acute mountain sickness. In: Sutton JR, Coates G, Houston CS, editors. Hypoxia and mountain medicine. Vol. 84. Adv Biosci 1992: 73–81

    Google Scholar 

  29. Fulco CS, Rock PB, Trad LA, et al. Increased physical-activity augments the incidence and severity of acute mountain sickness (AMS) during a simulated ascent to 4600m [abstract]. FASEBJ 1994; 8: A298

    Google Scholar 

  30. Wright AD, Fletcher RF. Acute mountain sickness. Postgrad Med J 1987; 63: 163–4

    Article  PubMed  CAS  Google Scholar 

  31. Coote JH, Bradwell AR, Winterborn MH, et al. Birmingham Medical Research Expiditionary Society. The use of Acetazolamide at altitude. Bulletin Union Int. des Assoc de Guides de Montagne 1985; 8: 1–4

    Google Scholar 

  32. Hackett PH. Mountain Sickness. Prevention, recognition and treatment. American Alpine Club. 6th ed. New York: American Alpine Club Inc, 1992

    Google Scholar 

  33. Weil JV, Kryger MH, Scoggin H. Sleep and breathing at high altitude. In: Guilleminault C, Dement WC, editors. Sleep apnoea syndromes. New York: Alan R. Liss Inc., 1978: 19–136

    Google Scholar 

  34. Harrison GL, Evans J, Coote JH. Discontinuation of acetazolamide after rapid ascent to 4300m. Sixth International Hypoxia Symposium; Feb 1989: Lake Louise, Canada. New York: Alan R. Liss Inc., 1990

  35. Jensen JB, Wright AD, Lassen NA, et al. Cerebral blood flow in acute mountain sickness. J Appl Physiol 1990; 69: 430–33

    PubMed  CAS  Google Scholar 

  36. Grissom CK, Roach RC, Sarnquist FH, et al. Acetazolamide in the treatment of acute mountain sickness and clinical efficacy and effect on gas exchange. Ann Intern Med 1992; 116: 461–5

    PubMed  CAS  Google Scholar 

  37. Cain SM, Dunn JE. Increase of arterial oxygen tension at altitude by carbonic anhydrase inhibition. J Appl Physiol 20; 1965: 882–4

    PubMed  CAS  Google Scholar 

  38. Forwand SA, Landowne M, Follansbee JN, et al. Effect of acetazolamide on acute mountain sickness. N Engl J Med 1968; 279: 839–45

    Article  PubMed  CAS  Google Scholar 

  39. Bradwell AR, Dykes PW, Coote JH, et al. Effect of acetazolamide on exercise performance and muscle mass at high altitude. Lancet 1986: 1001–5

    Google Scholar 

  40. Bradwell AR, Dykes PW, Coote JH. Effect of acetazolamide on exercise at altitude. Sports Med 4; 1987: 157–63

    Article  PubMed  CAS  Google Scholar 

  41. Sutton JR, Houston CS, Mansell AL, et al. Effect of acetazolamide on hypoxaemia during sleep at high altitude. N Engl J Med 1979; 301: 1329–31

    Article  PubMed  CAS  Google Scholar 

  42. Nicholson AN, Smith PA, Stone BM, et al. Altitude insomnia: studies during an expedition to the Himalayas. Sleep 1979; II: 354–61

    Google Scholar 

  43. Hackett PH, Roach RC, Harrison GL, et al. Respiratory stimulants and sleep periodic breathing. Almitrine versus Acetazolamide. Am Rev Respir Dis 1987; 135: 896–8

    PubMed  CAS  Google Scholar 

  44. Johnson TS, Rock PB, Fulco CS, et al. Prevention of acute mountain sickness by dexamethasone. N Engl J Med 1984; 310: 683–6

    Article  PubMed  CAS  Google Scholar 

  45. Ferrazzini G, Maggiorini M, Kriemler S, et al. Successful treatment of acute mountain sickness with dexamethasone. BMJ 1987; 294: 1380–2

    Article  PubMed  CAS  Google Scholar 

  46. Lands WEM, Sauter J, Stone GW. Oxygen requirements for prostaglandin biosynthesis. Prostaglandins Med 1978; 1: 117–120

    Article  PubMed  CAS  Google Scholar 

  47. Lote CJ, Haylor J. Eicosanoids in renal function. Prostaglandins, leukotrienes and essential fatty acids: Reviews 1989; 36: 203–17

    Article  CAS  Google Scholar 

  48. Flower RJ, Blackwell GJ. Anti-inflammatorysteroids induce biosynthesis of a phospholipase A2 inhibitor which prevents prostaglandin generation. Nature 1979; 278: 456–9

    Article  PubMed  CAS  Google Scholar 

  49. Gutin PH. Corticosteroid therapy in patients with cerebral tumours: benefits, problems, practicalities. Semin Oncol 1975; 2: 49–56

    PubMed  CAS  Google Scholar 

  50. Currie TT, Carter PH, Champion WL, et al. Spironolactone and acute mountain sickness. Med J Aust 1976; (II): 168–70

    Google Scholar 

  51. Jain SC, Sing MV, Sharma VM, et al. Amelioration of acute mountain sickness: comparative study of acetazolamide and spironolactone. Int J Biometeor 1986; 30: 293–300

    Article  CAS  Google Scholar 

  52. Goodland RL, Pommerenke WT. Cyclic fluctuation of the alveolar carbon dioxide tension during the normal menstrual cycle. Fertil Steril 1952; 3: 394–8

    PubMed  CAS  Google Scholar 

  53. Dempsey JA, Olson EB, Skatrud JB. Hormones and neurochemicals in the regulation of breathing. In: Handbook of physiology: the respiratory system. Vol. II. Pt 1. Bethesda: American Physiological Society, 1986: 181–221

    Google Scholar 

  54. Bradwell AR, Wright AD, Imray C, et al. Progesterone in acute mountain sickness. Hypoxia and mountain medicine [abstract]. Proceedings of the Ninth International Hypoxia Symposium; Feb 1995: Lake Louise, Canada, 1996

  55. Dickenson JG. Acetazolamide in acute mountain sickness. Postgrad Med J 1979; 55: 454–8

    Article  Google Scholar 

  56. Stanbrook HS, Morris KG, McMurtry IF. Prevention and reversal of hypoxic pulmonary hypertension by calcium antagonists. Am Rev Respir Dis 1984; 130: 81–5

    PubMed  CAS  Google Scholar 

  57. Oelz O, Ritter M, Jenni R, et al. Nifedipinefor high altitude pulmonary oedema. Lancet 1989; 11: 1241–4

    Article  Google Scholar 

  58. Bartsch P, Maggiorini M, Ritter M, et al. Prevention of high altitude pulmonary edema by Nifedipine. N Engl J Med 325: 1284–9, 1991

    Article  PubMed  CAS  Google Scholar 

  59. Hohenhaus E, Niroomand F, Goerre S, et al. Nifedipine does not prevent acute mountain sickness. Am J Respir Crit Care Med 1994; 150: 857–60

    PubMed  CAS  Google Scholar 

  60. Roach R, Hackett PH. Hyperbaric and high altitude illness. In Sutton JR, Coates G, Houston CS, editors. Hypoxia and mountain medicine. Vol. 84. Adv Biosci 1992: 266–73

    Google Scholar 

  61. Childs SB, Hamlin H, Henderson Y. Possible value of inhalation of carbon dioxide in climbing great altitudes. Nature 135; 1935: 457–8

    Article  Google Scholar 

  62. Harvey TC, Winterborn MH, Lassen NA, et al. The effect of carbon dioxide in acute mountain sickness: a rediscovery. Lancet 1988; 2: 639–41

    Article  PubMed  CAS  Google Scholar 

  63. Hackett P. Mechanisms of high altitude illness. In: Sutton JR, Coates G, Houston CS, editors. Hypoxia and mountain medicine. Vol. 84. Advances in the Biosciences. Oxford: Pergamon Press 1992: 292–5

    Google Scholar 

  64. Coote JH. Sleep at high altitude. In: Cooper R, Sleep. London: Chapman Hall 1994; 243–264

    Google Scholar 

  65. Selvamurthy W, Raju VRK, Ranganathan S, et al. Sleep patterns at an altitude of 3500 metres. Int J Biometeorol 1986; 30: 123–35

    Article  PubMed  CAS  Google Scholar 

  66. Coote JH, Tsang G, Baker A, et al. Polycythemia and central sleep apnoea in high altitude residents of the Andes. J Physiol (Lond) 1993;459: 749P

    Google Scholar 

  67. Coote JH, Tsang G, Baker A, et al. Respiratory changes and quality of sleep in young high altitude dwellers in the Andes of Peru. Eur J Appl Physiol 1993; 66: 249–53

    Article  CAS  Google Scholar 

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  1. Department of Physiology, The Medical School, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, England

    John H. Coote

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Coote, J.H. Medicine and Mechanisms in Altitude Sickness. Sports Med 20, 148–159 (1995). https://doi.org/10.2165/00007256-199520030-00003

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