Altitude sickness describes several symptoms that occur together and occur at high altitudes. It occurs when the body’s mechanisms for adapting to altitude fail, for example, by ascending too quickly. Therapy consists of a descent.
What is altitude sickness?
Altitude sickness occurs in people who live at high altitudes or go to high altitudes above 2000 meters. Due to a too rapid ascent and the resulting lack of oxygen to the brain, the affected person suffers from versatile symptoms such as loss of performance, fatigue, headaches, nausea and vomiting, breathing difficulties, dizziness, tinnitus and sleep disturbances. Decreased kidney function is also possible and leads to increased salt levels in the body. Depending on the severity, a distinction is made between the mild and severe forms of altitude sickness, in which life-threatening edema in the brain and/or lungs occurs in addition to the symptoms described above. It is interesting to note that the body can adapt to life at altitudes above 2500 meters: While many Andean people suffer from altitude sickness, Tibetans have a genetically required increased breathing rate that acts as protection against altitude sickness.
Causes
The cause of altitude sickness is that as altitude increases, the air pressure changes so that the lungs receive less oxygen. In addition, the intense exertion at these altitudes results in increased blood pressure, forcing fluid into the lungs. The interaction of these factors causes the body to be undersupplied with oxygen. The body reacts with a reflexive hyperventilation, and CO2 is increasingly expelled. This leads to hyperacidity of the blood with the first symptoms of altitude sickness and, if left untreated, to acute severe altitude sickness with edema and danger to life. Several risk factors favor the development of altitude sickness, including previous illness, overexertion, a too rapid ascent, insufficient fluid intake, and weakening of the body by alcohol, infections or sleeping pills and drugs.
Symptoms, complaints and signs
The most common symptoms of altitude sickness include shortness of breath, headache, dizziness and nausea. In many cases, these discomforts lead to vomiting. Furthermore, ill persons suffer from disturbed sleep patterns, which has a negative effect on the overall performance of the body. Further signs of an existing altitude sickness are dizziness, palpitations, cramps, high pulse and high blood pressure or dry cough. In addition, disorders of consciousness (slow to no reactions at all to environmental influences) occur, which shows a disturbed neurological background. It is imperative that these disorders be medically investigated. Sick persons are also prone to the formation of edema. Edemas are water deposits in the connective tissue under the skin. These are dangerous because they can become self-intensifying. Pressure increases within the blood vessels, damaging surrounding tissue and thus vital organs. In the worst case, however, edema can also form in the brain of the affected person. This is called high-altitude cerebral edema, which is life-threatening. In divers, the life-threatening high-altitude pulmonary edema can be observed. Both types of this symptomatology require immediate medical treatment.
Diagnosis and course
Because symptoms usually resolve on descent, the patient must rely on self-diagnosis and observation by companions. The first symptoms appear up to 24 hours before the onset of cerebral and pulmonary edema, allowing sufficient time for a controlled descent, the most important countermeasure. Signs of mild altitude sickness are headaches that occur along with any of the symptoms described above. If the affected person is already suffering from the severe form of altitude sickness with cerebral edema, the most important indication is a disturbance in the coordination of movement. Immediate countermeasures must be taken to rule out life-threatening courses and avert the fatal course of altitude sickness.
Complications
In altitude sickness, symptoms and complications always occur when the patient is at a high altitude and the body cannot adapt to the characteristics of the environment. In most cases, this results in nausea and headache, and often respiratory distress occurs.Due to the shortness of breath, it is not uncommon for a panic attack to occur. Furthermore, heart palpitations and loss of appetite may occur. The affected person is no longer able to work hard and cannot make any special physical efforts himself. Sleep disturbances may also occur, leading to increased fatigue. In severe cases, coordination disorders and impaired consciousness occur. In the worst case, symptoms of the brain or lungs can lead to the death of the patient. As a rule, altitude sickness cannot be treated directly, so that a descent may be necessary when symptoms appear. Often a very slow ascent is helpful, so that the affected person can get used to the new conditions. In this case, there are usually no further complications.
When should one go to the doctor?
A visit to the doctor is necessary as soon as health problems arise during a stay at higher altitudes. If no colds are present, symptoms such as headaches, dizziness or malaise are unusual and should be clarified by a doctor. Altitude sickness primarily affects people who spend time in areas that are above 2,000 meters. Intense symptoms often occur in people who live or work there. Since descent is not a permanent solution for these people, a visit to the doctor should be made as soon as life-impairing problems occur. If there are respiratory problems, persistent fatigue, weakness or a drop in performance level, a doctor is needed. If daily requirements can no longer be met, it is advisable to discuss the situation with a physician. Various measures can be taken to achieve an improvement in health. People who only temporarily visit regions at high altitudes should seek advice in advance on the correct behavior in the event of symptoms occurring. Often it is sufficient to take a break at the first symptoms or to leave the region again. A doctor is not needed in these cases. In case of severe circulatory problems, anxiety or loss of consciousness, a doctor should be consulted. If loss of consciousness occurs, an emergency physician must be notified.
Treatment and therapy
Treatment of altitude sickness consists of an immediate controlled descent to the nearest accessible rest area and at least one overnight stay at that location to allow the body sufficient rest. The descent must be initiated immediately, i.e., at night if necessary. It is generally better to treat altitude sickness on suspicion than to remain at the altitude reached or even to go higher. In some cases, recovery is sufficient and the ascent can be continued slowly. However, if symptoms persist, a brisk descent to safe altitudes below 2500 meters is the correct decision. In the case of pulmonary edema with coughing, unconsciousness and impaired consciousness, there is an acute danger to life and the ill person must be ventilated as quickly as possible, placed in a hyperbaric bag and brought out of the altitude. If transport by the companions is not possible, the mountain rescue team must be notified immediately. Although there is the possibility of acute treatment with dexamethasone in cases of severe altitude sickness, this must not be used under any circumstances to continue the ascent and is intended only as an immediate measure.
Prevention
Altitude sickness can occur regardless of physical condition, but with the observance of some basic rules its risk can be minimized: Attention should be paid to complete physical health, sufficient rest, slow acclimatization and avoidance of unnecessary efforts. Refraining from alcohol, drugs and medications and adequate hydration are indispensable measures.
Aftercare
Follow-up care is intended in particular to prevent the recurrence of a disease. For this reason, it takes place regularly after tumor diseases, for example, enabling early and life-saving treatment to be started. In the case of altitude sickness, however, such scheduled follow-up examinations do not make sense. On the one hand, this is because the typical symptoms can be easily avoided by avoiding high altitudes; on the other hand, the disease is permanent and cannot be treated according to the current state of scientific knowledge.Acute complications are best prevented by mountaineers by a slow ascent in which they gradually adapt to the changed conditions. Within scheduled follow-up examinations in the rooms of a doctor’s office, on the other hand, complaints are not encountered at all, since no ascent in altitude has taken place. Follow-up care does not prove to be effective here either. Aftercare is also about supporting the patient in everyday life. The physician can give behavioral advice regarding the next mountain hike. However, the patient is responsible for the implementation. In case of severe discomfort, the descent should be started immediately. On longer tours, accommodation at low levels is preferable. The ascent should be made slowly. It should be noted that the body needs time to adapt to the changed climatic conditions.
This is what you can do yourself
People who suffer from altitude sickness should always carry an altimeter. In many cars, it is already permanently integrated into the on-board system and can be called up at any time with current data. Nevertheless, it is advisable to carry an additional mobile device that can be worn on the body and also measures the altitude in real time. At the first symptoms of altitude sickness, the current position in which the person is located should be checked. As soon as possible, initiate a return to a much lower altitude and wait there for the symptoms to improve. Since altitude sickness can smoothly transition into a life-threatening condition, unnecessary risks should be avoided. A doctor must be called if symptoms worsen or drowsiness occurs. Staying at higher elevations should be well considered and planned. If possible, it should be avoided. Affected persons as well as close relatives should be fully informed about the disease, the symptoms and the resulting consequences. Spontaneous mountain tours should be avoided. Often the organism can adapt slowly to certain altitudes. Therefore, if a stay at certain altitudes is necessary, several days or weeks of time should be planned during which only gradual ascent takes place.
