Mountain sickness
Authors:
Jan Bultas
Authors place of work:
Ústav farmakologie 3. LF UK, Praha
Published in the journal:
Čas. Lék. čes. 2015; 154: 280-286
Category:
Review Article
Summary
Mountaineering brings many health risks, one of which is mountain sickness. Its mildest form - acute mountain sickness – is mainly characterized by subjective symptoms (headache, loss of appetite, insomnia, weakness, nausea and rarely also vomiting). Advanced and life-threatening forms are characterized by tissue edema – cerebral or pulmonary high altitude edema. The common denominator of these acute forms is the low oxygen tension leading to hypoxemia and tissue ischemia. Sum of maladaptive or adaptive processes can modify the clinical picture. Underlying mechanisms of the chronic forms of pulmonary disease are the adaptation processes – pulmonary hypertension and polycythemia leading to heart failure.
The only causal therapeutic intervention is to restore adequate oxygen tension, descend to lower altitudes or oxygen therapy. Pharmacotherapy has only a supportive effect. The prophylaxis includes stimulation of the respiratory center by carbonic anhydrase inhibitors (acetazolamide) antiedematous treatment with glucocorticoids (dexamethasone), increase lymphatic drainage of the lungs and brain by β2-agonists (salmeterol) or mitigation of pulmonary hypertension by calcium channel blockers or phosphodiesterase-5 inhibitors (sildenafil or tadalafil).
Keywords:
acute mountain sickness – high-altitude pulmonary edema – high-altitude cerebral edema – pathophysiology – clinical picture – treatment
Zdroje
1. Bloch KE, Turk AJ, Maggiorini M, et al. Effect of ascent protocol on acute mountain sickness and success at Muztagh Ata, 7546 m. High Alt Med Biol 2009; 10(1): 25–32.
2. Croughs M, Van Gompel A, Rameckers S, et al. Serious altitude illness in travelers who visited a pre-travel clinic, J Travel Med 2014; 21(6): 403–409.
3. Windsor JS, Firth PG, Grocott MP, et al. Mountain mortality: a review of deaths that occur during recreational activities in the mountains. Postgrad Med J 2009; 85(1004): 316–321.
4. West JB. Adventures in high-altitude physiology. Adv Exp Med Biol 2006; 588: 7–16.
5. West JB. The physiologic basis of high-altitude diseases. Ann Intern Med 2004; 141(10): 789–800.
6. Vinnikov D, Brimkulov N, Blanc PD, et al. Smoking increases the risk of acute mountain sickness. Wilderness Environ Med 2015; 26(2): 164–172.
7. Zhang E, Zhang J, Jin J, et al. Variants of the low oxygen sensors EGLN1 and HIF–1AN associated with acute mountain sickness. Int J Mol Sci 2014; 15(12): 21777–21787.
8. Ge RL, Shai HR, Takeoka M, et al. Atrial natriuretic peptide and red cell 2,3-diphosphoglycerate in patients with chronic mountain sickness. Wilderness Environ Med 2001; 12(1): 2–7.
9. Yoshino M, Murakami K, Katsumata Y, et al. Stimulation of anaerobic metabolism in rats at high altitude hypoxia–adrenergic effects dependent on dietary states. Comp Biochem Physiol B 1987; 88(2): 651–654.
10. CATMAT. Statement on high-altitude illnesses. An Advisory Committee Statement (ACS). Can Commun Dis Rep 2007; 33(ACS–5): 1–20.
11. Qi Y, Niu W, Zhu T, et al. Synergistic effect of the genetic polymorphisms of the renin-angiotensin-aldosterone system on high-altitude pulmonary edema: a study from Qinghai-Tibet altitude. Eur J Epidemiol 2008; 23(2): 143–152.
12. Bartsch P, Mairbäurl H, Maggiorini M, et al. Physiological aspects of high-altitude pulmonary edema. J Appl Physiol 2005; 98(3): 1101–1110.
13. Ge RL, Mo VY, Januzzi JL, et al. B-type natriuretic peptide, vascular endothelial growth factor, endothelin-1, and nitric oxide synthase in chronic mountain sickness. Am J Physiol Heart Circ Physiol 2011; 300(4): H1427–433.
14. Bärtsch P, Swenson ER. Clinical practice: Acute high-altitude illnesses. N Engl J Med 2013; 368: 2294–2302.
15. Ainslie PN, Subudhi AW. Cerebral blood flow at high altitude. High Alt Med Biol 2014; 15(2): 133–140.
16. Pichler HJ, Risch L, Hefti U, et al. Changes of coagulation parameters during high altitude expedition. Swiss Med Wkly 2010; 140(7–8): 111–117.
17. Shin T. High altitude illnesses in Hawai‘i. Hawaii J Med Public Health 2014; 73(11 Suppl 2): 4–6.
18. Luks AM, McIntosh SE, Grissom CK, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med 2014; 25(4 Suppl): S4–14.
19. Ritchie ND, Baggott AV, Todd WT. Acetazolamide for the prevention of acute mountain sickness – a systematic review and meta-analysis. J Travel Med 2012; 19(5): 298–307.
20. Luks AM, Swenson ER. Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness. Chest 2008; 133(3): 744–755.
21. Maggiorini M, Brunner-La Rocca HP, Peth S, et al. Both tadalafil and dexamethasone may reduce the incidence of high–altitude pulmonary edema: a randomized trial. Ann Intern Med 2006; 145(7): 497–506.
22. Wilson MH, Newman S, Imray CH, et al. The cerebral effects of ascent to high altitudes. Lancet Neurol 2009; 8(2): 175–191.
23. Jafarian S, Abolfazli R, Gorouhi F, et al. Gabapentin for prevention of hypobaric hypoxia-induced headache: randomized double-blind clinical trial. J Neurol Neurosurg Psychiatry 2008; 79(3): 321–323.
24. Pandit A, Karmacharya P, Pathak R, et al. Efficacy of NSAIDs for the prevention of acute mountain sickness: a systematic review and meta-analysis. J Community Hosp Intern Med Perspect. 2014;4(4).
25. Fagenholz PJ, Gutman JA, Murray AF, et al. Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt Med Biol 2007; 8(2): 139–146.
26. Aldashev AA, Kojonazarov BK, Amatov TA, et al. Phosphodiesterase type 5 and high altitude pulmonary hypertension. Thorax 2005; 60(8): 683–687.
27. Xu Y, Liu Y, Liu J, et al. Meta-analysis of clinical efficacy of sildenafil, a phosphodiesterase type-5 inhibitor on high altitude hypoxia and its complications. High Alt Med Biol 2014; 15(1): 46–51.
28. Perimenis P. Sildenafil for the treatment of altitude-induced hypoxaemia. Expert Opin Pharmacother 2005; 6(5): 835–837.
29. Sartori C, Allemann Y, Duplain H, et al. Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med 2002; 346(21): 1631–1636.
Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
Journal of Czech Physicians
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
- What Effect Can Be Expected from Limosilactobacillus reuteri in Mucositis and Peri-Implantitis?
Najčítanejšie v tomto čísle
- Mountain sickness
- Non-cardiogenic pulmonary edema, acute respiratory distress syndrome
- Chronic heart failure
- Analysis of the relationship of heavy/light chain pairs of immunoglobulin (Hevylite™) to the results of gel electrophoresis and nefelometric examination of serum proteins at the time of multiple myeloma diagnosis