Altitude sickness

Written by Dr Charlie Easmon, specialist adviser in travel medicine

High altitude pulmonary oedema (HAPE)
The symptoms of HAPE are predominantly severe and include increasing difficulty breathing, dry cough, pressure in the chest, palpitations and fatigue. A bubbling noise may be heard during breathing (oedema in the lungs). The lips, outer edges of the ears and nails may look blue (cyanosed) due to a shortage of oxygen.

The patient should be transported to the lowest possible altitude as soon as possible.

If possible, oxygen should be given by nasal catheter, or if an oxygen mask and bottle are available as CPAP (continuous positive airways pressure), or better still, hyperbaric treatment (Gamow-bag).

A calcium antagonist (nifedipine capsules 10-20mg [quick-acting] should be given - this must not be repeated, but followed by slower acting nifedipine tablets 20mg every six hours).

Dexamethasone injection (into a vein or a muscle) should be given.

The victim should be transported sitting on a stretcher or something similar.

High altitude cerebral oedema (HACE)
The symptoms of HACE are essentially very severe headache, visual disturbances, light shunning, irritability, vomiting, vagueness and confusion, possible unconsciousness and convulsions.

The patient should be transported to the lowest possible altitude as soon as possible.

Oxygen (CPAP) or better still, hyperbaric treatment (Gamow-bag) should be given.

Dexamethasone injection (into a vein or a muscle) should be given.

Convulsions may be treated with a benzodiazepine - eg diazepam.

Transportation should be in the natal position (strapped lateral) to avoid vomit getting into the lungs.

Who should never be exposed to high altitude?

People with chronic diseases of the heart/lungs (eg angina pectoris or chronic bronchitis, emphysema and some people with severe asthma).

People with anaemia, including sickle-cell anaemia (low haemoglobin content in the blood).

People with untreated blood clotting disorders and a history of thromboses (clots).

People who have previously developed HAPE or HACE.

Who should be careful at high altitude?

People with successfully treated heart/lung diseases (eg emphysema, asthma).

Pregnant women.

Children.

People with severe diabetes.

People with high blood pressure.

People with a tendency to sleep apnoea.

People who have previously developed HAPE or HACE.

Other problems to consider are the prevention of sunburn, snowblindness, cold, frostbite and sunburn.

UK information sources
British Mountaineering Council (BMC), 177-179 Burton Road, West Didsbury, Manchester M20 2BB. Tel: +44 161 4454747. Fax: +44 161 4454500. E-mail: info@thebmc.co.uk.

Expedition Advisory Centre, Royal Geographic Centre, 1 Kensington Gore, London SW7 2AR, Tel: +44 171 591 3030. Fax: +44 171 5913031. E-mail: eac@rgs.org.

Additional information from: Expedition Medicine by Profile Books ISBN 1 86197 040 4.

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