Skip to main content
  • 267 Accesses

Abstract

Acute high-altitude sickness includes various symptoms and pathology that a non-acclimatized individual experiences while travelling to higher altitudes. People travelling to high altitudes face different forms of illness (HAI) due to hypobaric hypoxia which leads to a combination of one or more syndromes including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Lack of negligible side-effect, not so specific prophylactics and difficulties in diagnosis of acclimatization markers have led to several difficulties for the travellers. Various factors affect the occurrence of HAI that including the pace of climbing, the rate of change in altitude and genetic, environmental and epigenetic factors that code for hypoxia-inducible factors, transcription factors that affect genetic expression in response to oxygen concentrations. This chapter deals with current problems in the diagnosis of high altitude sickness and strategies that are crucial in the prevention of high-altitude related disorders. The most effective intervention for treatment to date remains the descent; however, it is not always possible to immediate descent and we need to consider other forms of interventions. In this chapter, we will also provide important insights into preventive and therapeutic approaches required for the management of various forms of high-altitude illnesses.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aksel G, Çorbacıoğlu ŞK, Özen C (2019) High-altitude illness: management approach. Turk J Emerg Med 19(4):121–126

    Article  PubMed  PubMed Central  Google Scholar 

  • Aoki VS, Robinson SM (1971) Body hydration and the incidence and severity of acute mountain sickness. J Appl Physiol 31:363–367

    Article  CAS  PubMed  Google Scholar 

  • Bartsch P, Bailey DM (2014) Acute mountain sickness and high altitude cerebral oedema. In: Swenson ER, Bartsch P (eds) High altitude human adaptation to hypoxia. Springer, New York, pp 379–404

    Google Scholar 

  • Bärtsch P, Merki B, Hofstetter D, Maggiorini M, Kayser B, Oelz O (1993) Treatment of acute mountain sickness by simulated descent: a randomised controlled trial. BMJ 306(6885):1098–1101

    Article  PubMed  PubMed Central  Google Scholar 

  • Bärtsch P, Maggiorini M, Mairbäurl H, Vock P, Swenson ER (2002) Pulmonary extravascular fluid accumulation in climbers. Lancet 360(9332):571

    Article  PubMed  Google Scholar 

  • Basnyat B, Murdoch DR (2003) High-altitude illness. Lancet 361(9373):1967–1974

    Article  PubMed  Google Scholar 

  • Basnyat B, Subedi D, Sleggs J, Lemaster J, Bhasyal G, Aryal B, Subedi N (2000) Disoriented and ataxic pilgrims: an epidemiological study of acute mountain sickness and high-altitude cerebral edema at a sacred lake at 4300 m in the Nepal Himalayas. Wilderness Environ Med 11(2):89–93

    Article  CAS  PubMed  Google Scholar 

  • Beidleman BA, Muza SR, Fulco CS, Cymerman A, Ditzler D, Stulz D, Staab JE, Skrinar GS, Lewis SF, Sawka MN (2004) Intermittent altitude exposures reduce acute mountain sickness at 4300 m. Clin Sci (Lond) 106(3):321–328

    Article  Google Scholar 

  • Bezruchka S (1994) Altitude illness, prevention and treatment. Cordee, Leicester

    Google Scholar 

  • Broome JR, Stoneham MD, Beeley JM, Milledge JS, Hughes AS (1994) High altitude headache: treatment with ibuprofen. Aviat Space Environ Med 65(1):19–20

    CAS  PubMed  Google Scholar 

  • Canouï-Poitrine F, Veerabudun K, Larmignat P, Letournel M, Bastuji-Garin S, Richalet JP (2014) Risk prediction score for severe high altitude illness: a cohort study. PLoS One 9(7):e100642

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Castellani JW, Muza SR, Cheuvront SN, Sils IV, Fulco CS, Kenefick RW, Beidleman BA, Sawka MN (2010) Effect of hypohydration and altitude exposure on aerobic exercise performance and acute mountain sickness. J Appl Physiol 109(6):1792–1800

    Article  PubMed  Google Scholar 

  • Chen GZ, Zheng CR, Qin J, Yu J, Wang H, Zhang JH, Hu MD, Dong JQ, Guo WY, Lu W, Zeng Y, Huang L (2015) Inhaled budesonide prevents acute mountain sickness in young Chinese men. J Emerg Med 48(2):197–206

    Article  PubMed  Google Scholar 

  • Curtis R (1995) Outdoor action guide to high altitude: acclimatization and illnesses. Outdoor Action Program, Princeton University, Princeton, NJ

    Google Scholar 

  • Davis C, Hackett P (2017) Advances in the prevention and treatment of high altitude illness. Emerg Med Clin North Am 35(2):241–260

    Article  PubMed  Google Scholar 

  • Dehnert C, Böhm A, Grigoriev I, Menold E, Bärtsch P (2014 Sep) Sleeping in moderate hypoxia at home for prevention of acute mountain sickness (AMS): a placebo-controlled, randomized double-blind study. Wilderness Environ Med 25(3):263–271

    Article  PubMed  Google Scholar 

  • Ellsworth AJ, Larson EB, Strickland D (1987) A randomized trial of dexamethasone and acetazolamide for acute mountain sickness prophylaxis. Am J Med 83(6):1024–1030

    Article  CAS  PubMed  Google Scholar 

  • Fagenholz PJ, Gutman JA, Murray AF, Harris NS (2007 Summer) Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt Med Biol 8(2):139–146

    Article  PubMed  Google Scholar 

  • Ferrazzini G, Maggiorini M, Kriemler S, Bärtsch P, Oelz O (1987) Successful treatment of acute mountain sickness with dexamethasone. Br Med J (Clin Res Ed) 294(6584):1380–1382

    Article  CAS  Google Scholar 

  • Fischer R, Vollmar C, Thiere M, Born C, Leitl M, Pfluger T, Huber RM (2004) No evidence of cerebral oedema in severe acute mountain sickness. Cephalalgia 24(1):66–71

    Article  CAS  PubMed  Google Scholar 

  • Fulco CS, Muza SR, Beidleman BA, Demes R, Staab JE, Jones JE, Cymerman A (2011) Effect of repeated normobaric hypoxia exposures during sleep on acute mountain sickness, exercise performance, and sleep during exposure to terrestrial altitude. Am J Physiol Regul Integr Comp Physiol 300(2):R428–R436

    Article  CAS  PubMed  Google Scholar 

  • Gabry AL, Ledoux X, Mozziconacci M, Martin C (2003) High-altitude pulmonary edema at moderate altitude (< 2,400 m; 7,870 feet): a series of 52 patients. Chest 123(1):49–53

    Article  PubMed  Google Scholar 

  • Gertsch JH, Basnyat B, Johnson EW, Onopa J, Holck PS (2004) Randomised, double blind, placebo controlled comparison of ginkgo biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers: the prevention of high altitude illness trial (PHAIT). Br Med J 328(7443):797

    Article  CAS  Google Scholar 

  • Grissom CK, Roach RC, Sarnquist FH, Hackett PH (1992) Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange. Ann Intern Med 116(6):461–465

    Article  CAS  PubMed  Google Scholar 

  • Hackett PH (2010) Caffeine at high altitude: java at base cAMP. High Alt Med Biol 11:13–17

    Article  CAS  PubMed  Google Scholar 

  • Hackett PH, Rennie D, Hofmeister SE, Grover RF, Grover EB, Reeves JT (1982) Fluid retention and relative hypoventilation in acute mountain sickness. Respiration 43:321–329

    Article  CAS  PubMed  Google Scholar 

  • Hackett PH, Roach RC, Wood RA, Foutch RG, Meehan RT, Rennie D, Mills WJ Jr (1988) Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med 59(10):950–954

    CAS  PubMed  Google Scholar 

  • Hall DP, Duncan K, Baillie JK (2011) High altitude pulmonary oedema. J R Army Med Corps 157(1):68–72

    Article  CAS  PubMed  Google Scholar 

  • Harris NS, Wenzel RP, Thomas SH (2003) High altitude headache: efficacy of acetaminophen vs. ibuprofen in a randomized, controlled trial. J Emerg Med 24:383–387

    Article  PubMed  Google Scholar 

  • Honigman B, Theis MK, Koziol-McLain J, Roach R, Yip R, Houston C, Moore LG (1993) Acute mountain sickness in a general tourist population at moderate altitudes. Ann Intern Med 118(8):587–592

    Article  CAS  PubMed  Google Scholar 

  • Imray C, Wright A, Subudhi A, Roach R (2010) Acute mountain sickness: pathophysiology, prevention, and treatment. Prog Cardiovasc Dis 52:467–484

    Article  CAS  PubMed  Google Scholar 

  • Jones BE, Stokes S, McKenzie S, Nilles E, Stoddard GJ (2013) Management of high altitude pulmonary edema in the Himalaya: a review of 56 cases presenting at Pheriche medical aid post (4240 m). Wilderness Environ Med 24(1):32–36

    Article  PubMed  Google Scholar 

  • Joyce KE, Lucas SJE, Imray CHE, Balanos GM, Wright AD (2018) Advances in the available non-biological pharmacotherapy prevention and treatment of acute mountain sickness and high altitude cerebral and pulmonary oedema. Expert Opin Pharmacother 19(17):1891–1902

    Article  CAS  PubMed  Google Scholar 

  • Kallenberg K, Bailey DM, Christ S, Mohr A, Roukens R, Menold E, Steiner T, Bärtsch P, Knauth M (2007) Magnetic resonance imaging evidence of cytotoxic cerebral edema in acute mountain sickness. J Cereb Blood Flow Metab 27(5):1064–1071

    Article  PubMed  Google Scholar 

  • Kriemler S, Bürgi F, Wick C, Wick B, Keller M, Wiget U, Schindler C, Kaufmann BA, Kohler M, Bloch K, Brunner-La Rocca HP (2014) Prevalence of acute mountain sickness at 3500 m within and between families: a prospective cohort study. High Alt Med Biol 15(1):28–38

    Article  CAS  PubMed  Google Scholar 

  • Levine BD, Yoshimura K, Kobayashi T, Fukushima M, Shibamoto T, Ueda G (1989) Dexamethasone in the treatment of acute mountain sickness. N Engl J Med 321(25):1707–1713

    Article  CAS  PubMed  Google Scholar 

  • Lipman GS, Kanaan NC, Holck PS, Constance BB, Gertsch JH, PAINS Group (2012) Ibuprofen prevents altitude illness: a randomized controlled trial for prevention of altitude illness with nonsteroidal anti-inflammatories. Ann Emerg Med 59(6):484–490

    Article  PubMed  Google Scholar 

  • Lobenhoffer H, Zink R, Brendel W (1982) High altitude pulmonary edema: analysis of 166 cases. In: High altitude physiology and medicine, pp 219–231

    Chapter  Google Scholar 

  • Low EV, Avery AJ, Gupta V, Schedlbauer A, Grocott MP (2012) Identifying the lowest effective dose of acetazolamide for the prophylaxis of acute mountain sickness: systematic review and meta-analysis. BMJ 345:e6779

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, Zafren K, Hackett PH, Wilderness Medical Society (2014) Wilderness medical society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med 25(4 Suppl):S4–S14

    Article  PubMed  Google Scholar 

  • Luks AM, Swenson ER, Bärtsch P (2017) Acute high-altitude sickness. Eur Respir Rev 26(143):160096

    Article  PubMed  Google Scholar 

  • Luks AM, Auerbach PS, Freer L, Grissom CK, Keyes LE, McIntosh SE, Rodway GW, Schoene RB, Zafren K, Hackett PH (2019) Wilderness medical society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. Wilderness Environ Med 30(4S):S3–S18

    Article  PubMed  Google Scholar 

  • Maggiorini M (2010) Prevention and treatment of high-altitude pulmonary edema. Prog Cardiovasc Dis 52(6):500–506

    Article  CAS  PubMed  Google Scholar 

  • Maggiorini M, Muller A, Hofstetter D, Bartsch P, Oelz O (1998) Assessment of acute mountain sickness by different score protocols in the Swiss Alps. Aviat Space Environ Med 69(12):1186–1192

    CAS  PubMed  Google Scholar 

  • Maggiorini M, Brunner-La Rocca HP, Peth S, Fischler M, Böhm T, Bernheim A, Kiencke S, Bloch KE, Dehnert C, Naeije R, Lehmann T, Bärtsch P, Mairbäurl H (2006) Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med 145(7):497–506

    Article  PubMed  Google Scholar 

  • McIntosh SE, Hemphill M, McDevitt MC, Gurung TY, Ghale M, Knott JR, Thapa GB, Basnyat B, Dow J, Weber DC, Grissom K, C. (2019) Reduced acetazolamide dosing in countering altitude illness: a comparison of 62.5 vs 125 mg (the RADICAL trial). Wilderness Environ Med 30(1):12–21

    Article  PubMed  Google Scholar 

  • Moraga FA, Flores A, Serra J, Esnaola C, Barriento C (2007) Ginkgo biloba decreases acute mountain sickness in people ascending to high altitude at Ollagüe (3696 m) in northern Chile. Wilderness Environ Med 18(4):251–257

    Article  PubMed  Google Scholar 

  • Oelz O, Maggiorini M, Ritter M, Waber U, Jenni R, Vock P, Bärtsch P (1989) Nifedipine for high altitude pulmonary oedema. Lancet 2(8674):1241–1244

    Article  CAS  PubMed  Google Scholar 

  • Palmer BF (2010) Physiology and pathophysiology with ascent to altitude. Am J Med Sci 340(1):69–77

    Article  PubMed  Google Scholar 

  • Pasha MA, Newman JH (2010) High-altitude disorders: pulmonary hypertension: pulmonary vascular disease: the global perspective. Chest 137(Suppl 6):13–19

    Article  Google Scholar 

  • Paul S, Gangwar A, Bhargava K, Khurana P, Ahmad Y (2018) Diagnosis and prophylaxis for high-altitude acclimatization: adherence to molecular rationale to evade high-altitude illnesses. Life Sci 203:171–176

    Article  CAS  PubMed  Google Scholar 

  • Pennardt A (2013) High-altitude pulmonary edema: diagnosis, prevention, and treatment. Curr Sports Med Rep 12(2):115–119

    Article  PubMed  Google Scholar 

  • Pollard AJ, Niermeyer S, Barry P, Bärtsch P, Berghold F, Bishop RA, Clarke C, Dhillon S, Dietz TE, Durmowicz A, Durrer B, Eldridge M, Hackett P, Jean D, Kriemler S, Litch JA, Murdoch D, Nickol A, Richalet JP, Roach R, Shlim DR, Wiget U, Yaron M, Zubieta-Castillo G Sr, Zubieta-Calleja GR Jr (2001) Children at high altitude: an international consensus statement by an ad hoc committee of the International Society for Mountain Medicine, march 12, 2001. High Alt Med Biol 2(3):389–403

    Article  CAS  PubMed  Google Scholar 

  • Roach R, Bartsch P, Hackett P, Oelz O (1993) The Lake Louise acute mountain sickness scoring system. Hypoxia Mol Med 272:4

    Google Scholar 

  • Sartori C, Allemann Y, Duplain H, Lepori M, Egli M, Lipp E, Hutter D, Turini P, Hugli O, Cook S, Nicod P, Scherrer U (2002) Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med 346(21):1631–1636

    Article  CAS  PubMed  Google Scholar 

  • Scherrer U, Rexhaj E, Jayet PY, Allemann Y, Sartori C (2010) New insights in the pathogenesis of high-altitude pulmonary edema. Prog Cardiovasc Dis 52(6):485–492

    Article  PubMed  Google Scholar 

  • Schommer K, Wiesegart N, Menold E, Haas U, Lahr K, Buhl H, Bärtsch P, Dehnert C (2010) Training in normobaric hypoxia and its effects on acute mountain sickness after rapid ascent to 4559 m. High Alt Med Biol 11(1):19–25

    Article  PubMed  Google Scholar 

  • Schommer K, Kallenberg K, Lutz K, Bärtsch P, Knauth M (2013) Hemosiderin deposition in the brain as footprint of high-altitude cerebral edema. Neurology 81(20):1776–1779

    Article  CAS  PubMed  Google Scholar 

  • Singh I, Kapila CC, Khanna PK, Nanda RB, Rao BD (1965) High altitude pulmonary oedema. Lancet 1(7379):229–234

    Article  CAS  PubMed  Google Scholar 

  • Smedley T, Grocott MP (2013) Acute high-altitude illness: a clinically orientated review. Br J Pain 7(2):85–94

    Article  PubMed  PubMed Central  Google Scholar 

  • Stream JO, Grissom CK (2008) Update on high-altitude pulmonary edema: pathogenesis, prevention, and treatment. Wilderness Environ Med 19(4):293–303

    Article  PubMed  Google Scholar 

  • Subedi BH, Pokharel J, Goodman TL, Amatya S, Freer L, Banskota N, Johnson E, Basnyat B (2010) Complications of steroid use on Mt. Everest. Wilderness Environ Med 21(4):345–348

    Article  PubMed  Google Scholar 

  • Swenson ER (2014) The lungs in acute mountain sickness: victim, perpetrator, or both? Am J Med 127:899–900

    Article  PubMed  Google Scholar 

  • Taber RL (1990) Protocols for the use of portable hyperbaric chambers for the treatment of high-altitude disorders. J Wilderness Med 1:181–192

    Article  Google Scholar 

  • Walmsley M (2013) Continuous positive airway pressure as adjunct treatment of acute altitude illness. High Alt Med Biol 14(4):405–407

    Article  PubMed  Google Scholar 

  • Wilson MH, Milledge J (2008) Direct measurement of intracranial pressure at high altitude and correlation of ventricular size with acute mountain sickness: Brian Cummins’ results from the 1985 Kishtwar expedition. Neurosurgery 63(5):970–974

    Article  PubMed  Google Scholar 

  • Zafren K (1998) Gamow bag for high-altitude cerebral oedema. Lancet 352:325–326

    Article  CAS  PubMed  Google Scholar 

  • Zafren K, Honigman B (1997) High altitude medicine. Emerg Med Clin N Am 15(1):191–222

    Article  CAS  Google Scholar 

  • Zafren K, Reeves JT, Schoene R (1996) Treatment of high-altitude pulmonary edema by bed rest and supplemental oxy- gen. Wilderness Environ Med 7(2):127–132

    Article  CAS  PubMed  Google Scholar 

  • Zheng CR, Chen GZ, Yu J, Qin J, Song P, Bian SZ, Xu BD, Tang XG, Huang YT, Liang X, Yang J, Huang L (2014) Inhaled budesonide and oral dexamethasone prevent acute mountain sickness. Am J Med 127(10):1001–1009.e2

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gurpreet Kaur .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kaur, G. (2022). Current Problems in Diagnosis and Treatment of High-Altitude Sickness. In: Sharma, N.K., Arya, A. (eds) High Altitude Sickness – Solutions from Genomics, Proteomics and Antioxidant Interventions. Springer, Singapore. https://doi.org/10.1007/978-981-19-1008-1_7

Download citation

Publish with us

Policies and ethics