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ALTITUDE SICKNESS
ALTITUDE SICKNESS
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GENERAL INFORMATION
DESCRIPTIONAltitude sickness refers to any of several illnesses associated with higher-than-usual altitudes. The illnesses are of several types, including acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), high altitude cerebral edema (HACE), high altitude retinal hemorrhage (HARH), and subacute and chronic mountain sickness (CMS). (CMS is a complication that represents failure to recover from AMS over a long period of time.) Other altitude-related problems include frostbite, blood clots in the legs and lungs, dehydration, and swollen feet and ankles. Pre-existing illnesses that are aggravated by high altitude include sickle-cell disease or trait, chronic heart disease, and chronic lung disease. Altitude illnesses affect most body systems, especially the brain, heart, lungs, gastrointestinal tract, circulatory system, and electrolytes. Appropriate health care includes self-care and doctor's treatment; hospitalization (severe cases).
SIGNS & SYMPTOMS
AMS: Headache, nausea, vomiting, shortness of breath, and sleep disturbances.
HAPE: Shortness of breath, cough, weakness, headache, and coma.
HACE: Severe headache, staggering gait, hallucinations, and stupor. These indicate swelling of the brain. Death will occur without descent.
HARH: Visual disturbances, including spots before the eyes. Blood clots and bleeding into the retina occur in 50% of those who go above 17,000 feet.
CMS: Shortness of breath, fatigue, bloated face and body, congestive heart failure after years of living at high altitude (rare).
CAUSES
Insufficient oxygen at high altitudes. Following are the altitudes at which each type of illness can occur in your child:
AMS: 7,000 to 8,000 feet or higher.
HAPE: 9,000 to 10,000 feet.
HACE: 10,000 to 12,000 feet.
HARH: 17,000 feet.
RISK FACTORS
Fatigue or overwork; previous episodes of altitude illness; chronic illness of any sort, particularly cardiovascular and lung diseases; obesity; excess alcohol consumption; use of mind-altering drugs, including narcotics and tranquilizers.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should avoid ascending to heights that cause symptoms. If it is necessary to climb, the child should become acclimatized gradually by a slow ascent.
BASIC INFORMATION
MEDICAL TESTSYour own observation of symptoms; medical history and physical exam by a doctor; laboratory studies such as EKG and chest X-ray.
POSSIBLE COMPLICATIONSPermanent brain, eye, heart, and lung damage. The worst cases of HAPE and HACE can lead to death.
PROBABLE OUTCOME
Usually curable without residual impairment after the child returns to lower altitudes.
TREATMENT
HOME CAREYour child should follow these instructions:
AMS: Descend to lower altitude if illness lasts 2 or more days.
HAPE: Oxygen, rest, and diuretics help, but rapid descent is usually necessary.
HACE: Oxygen and corticosteroids help, but rapid descent to lower altitudes is the only certain way for the child to recover.
HARH: No treatment except to descend.
CMS: The child should return to lower altitudes if symptoms persist.
MEDICATION
Your doctor may prescribe:
For AMS: diamox (carbonic anhydrase inhibitor).
For HAPE: oxygen, furosemide (diuretic), morphine (narcotic pain reliever).
For HACE: corticosteroids.
ACTIVITY
If any altitude illness occurs, your child should decrease activity to a level at which symptoms disappear. The child can resume activity gradually upon returning to normal altitude.
DIET & FLUIDS
No special diet.
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has symptoms of any altitude illness.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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From Complete Guide to Pediatric Symptoms, Illness & Medications by H. Winter Griffith, M.D. Copyright by Putnam Publishing
Group. Electronic rights by Medical Data Exchange.
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