Acute high-altitude illness

Abstract

A substantial proportion of South Africa (SA)’s population lives at high altitude (>1 500 m), and many travel to very high altitudes (>3 500 m) for tourism, business, recreation or religious pilgrimages every year. Despite this, knowledge of acute altitude illnesses is poor among SA doctors. At altitude, the decreasing ambient pressure proportionally decreases available oxygen (hypobaric hypoxia). This triggers both immediate respiratory compensation and gradual acclimatisation that occurs over days to weeks. Rapid ascents to altitudes above 2 500 m can precipitate acute altitude illness, including acute mountain sickness (AMS) and high-altitude pulmonary and cerebral oedema (HAPE and HACE). The best preventive measure is gradual ascent (no more than 300 - 500 m increase in sleeping altitude per day, with additional rest days for acclimatisation for every 1 000 m altitude gain), although chemoprophylaxis may speed acclimatisation. In the field, AMS, HAPE and HACE are diagnosed clinically. The Lake Louise Score questionnaire is used to elicit symptoms of AMS, and can be supplemented by assessing clinical signs such as tachycardia, tachypnoea, crepitations or ronchi, and ataxia. The mainstay of treatment for all but mild AMS is rapid descent to lower altitudes, which can be facilitated by administration of oxygen and drugs, including acetazolamide, dexamethasone and nifedipine, or use of a portable hyperbaric chamber.