Common High Altitude Illnesses
Janet Sweetman, MD. PGY-3 Emergency Medicine Lansing, MI. Jan 2001
Since Telluride
is at 8750 feet, the Medical Center sees its share of altitude related
illnesses. Although most people living here year round should not suffer
from these problems, it is important for everyone living at altitude to
know a little bit about common high altitude illnesses, especially when
friends and relatives from the flatlands arrive in town. Residents of
Telluride who return from trips to the lowlands are also susceptible to
altitude problems.
Acute Mountain Sickness (AMS) occurs in a spectrum from mild to severe and even life threatening. Age, sex, and level of fitness have little to do with who might be affected. The most common symptoms of AMS are headache, fatigue, dizziness and nausea, and are quite similar to those of a hangover. Sleep is often disturbed the first several nights. People most likely to be affected are those who ascend rapidly to an altitude over 7500 feet.
More serious complications of AMS are High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE). HAPE is a condition characterized by fluid buildup in the lungs. Symptoms of HAPE most commonly occur on the second night and start with fatigue and shortness of breath. Often mild AMS symptoms are present as well. A dry cough develops, and the lips and nailbeds may take on a bluish tinge. The condition usually worsens at night and audible congestion may be heard in the chest. If the affected person does not receive appropriate treatment, fluid will continue to accumulate in the lungs and the person may die.
HACE is a condition that occurs in the setting of AMS or HAPE, and is characterized by brain swelling. The classic symptoms of HACE are uncoordinated gait, confusion, impaired thinking, drowsiness, stupor and coma. The progression from AMS to HACE may occur within 12 hours, but usually takes 1-3 days. Again, if not treated appropriately, it will progress to coma and death.
The ideal treatment for all forms of AMS is descent! However, the milder forms can often be self-treated or treated here at the Medical Center. Oxygen is the mainstay of treatment and can often reduce or eliminate mild symptoms. A medication called Diamox can also be helpful. Diamox is a prescription medication, which can be prescribed at home by the visitor's family physician and started the day before ascending, but is also effective once AMS symptoms have started. It affects the taste of carbonated beverages and should not be taken by anyone who has an allergy to sulfa. Once symptoms of HAPE or HACE develop, the affected person needs to be seen by a physician and will often need to be transported to a lower altitude.
There are a number of things the visitor to altitude can do on his/her own to help acclimatization. Alcohol and caffeine should be avoided the first day or two. Contrary to popular opinion, alcohol is not more potent at altitude, but it can certainly worsen AMS symptoms. Fluid intake should be increased to 3 to 4 liters per day. Strenuous activity should be minimized the first day or two. Sleeping pills should be avoided - they can decrease the respiratory rate and worsen symptoms. Mild headaches can be treated with over the counter analgesics, such as ibuprofen or Tylenol.
There are a number of illnesses that are adversely affected by altitude. People with sickle cell disease, severe emphysema, pulmonary hypertension and severe congestive heart failure should not ascend to altitudes much over 5000 feet. People with the following conditions should seek the advice of a physician before visiting the high mountains: moderate emphysema, heart arrhythmias, coronary artery disease, high risk pregnancy, and sickle cell trait. Asthma patients are usually not adversely affected by altitude, but persons with asthma should make sure they have their medications with them.
There is also a little known condition called HAFE or High Altitude Flatus Expulsion. Just as it sounds, this is the unwelcome expulsion of colonic gas at altitudes greater than 8000 feet. It is due to the expansion of gas at the decreased atmospheric pressure found at altitude. While not serious, this condition can be quite painful and odiferous. It is best treated with simethicone (available over the counter) and avoidance of gas forming foods.
The mountains are an incredible place to visit and a little common sense goes a long way in making a visit enjoyable and safe. I would like to thank the staff of the Telluride Medical Center and the people of Telluride for making my stay here a wonderful experience.
Acute Mountain Sickness (AMS) occurs in a spectrum from mild to severe and even life threatening. Age, sex, and level of fitness have little to do with who might be affected. The most common symptoms of AMS are headache, fatigue, dizziness and nausea, and are quite similar to those of a hangover. Sleep is often disturbed the first several nights. People most likely to be affected are those who ascend rapidly to an altitude over 7500 feet.
More serious complications of AMS are High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE). HAPE is a condition characterized by fluid buildup in the lungs. Symptoms of HAPE most commonly occur on the second night and start with fatigue and shortness of breath. Often mild AMS symptoms are present as well. A dry cough develops, and the lips and nailbeds may take on a bluish tinge. The condition usually worsens at night and audible congestion may be heard in the chest. If the affected person does not receive appropriate treatment, fluid will continue to accumulate in the lungs and the person may die.
HACE is a condition that occurs in the setting of AMS or HAPE, and is characterized by brain swelling. The classic symptoms of HACE are uncoordinated gait, confusion, impaired thinking, drowsiness, stupor and coma. The progression from AMS to HACE may occur within 12 hours, but usually takes 1-3 days. Again, if not treated appropriately, it will progress to coma and death.
The ideal treatment for all forms of AMS is descent! However, the milder forms can often be self-treated or treated here at the Medical Center. Oxygen is the mainstay of treatment and can often reduce or eliminate mild symptoms. A medication called Diamox can also be helpful. Diamox is a prescription medication, which can be prescribed at home by the visitor's family physician and started the day before ascending, but is also effective once AMS symptoms have started. It affects the taste of carbonated beverages and should not be taken by anyone who has an allergy to sulfa. Once symptoms of HAPE or HACE develop, the affected person needs to be seen by a physician and will often need to be transported to a lower altitude.
There are a number of things the visitor to altitude can do on his/her own to help acclimatization. Alcohol and caffeine should be avoided the first day or two. Contrary to popular opinion, alcohol is not more potent at altitude, but it can certainly worsen AMS symptoms. Fluid intake should be increased to 3 to 4 liters per day. Strenuous activity should be minimized the first day or two. Sleeping pills should be avoided - they can decrease the respiratory rate and worsen symptoms. Mild headaches can be treated with over the counter analgesics, such as ibuprofen or Tylenol.
There are a number of illnesses that are adversely affected by altitude. People with sickle cell disease, severe emphysema, pulmonary hypertension and severe congestive heart failure should not ascend to altitudes much over 5000 feet. People with the following conditions should seek the advice of a physician before visiting the high mountains: moderate emphysema, heart arrhythmias, coronary artery disease, high risk pregnancy, and sickle cell trait. Asthma patients are usually not adversely affected by altitude, but persons with asthma should make sure they have their medications with them.
There is also a little known condition called HAFE or High Altitude Flatus Expulsion. Just as it sounds, this is the unwelcome expulsion of colonic gas at altitudes greater than 8000 feet. It is due to the expansion of gas at the decreased atmospheric pressure found at altitude. While not serious, this condition can be quite painful and odiferous. It is best treated with simethicone (available over the counter) and avoidance of gas forming foods.
The mountains are an incredible place to visit and a little common sense goes a long way in making a visit enjoyable and safe. I would like to thank the staff of the Telluride Medical Center and the people of Telluride for making my stay here a wonderful experience.
