Acute Mountain Sickness (Acosta Syndrome)

Acute mountain sickness is a type of altitude sickness which develops within a few hours of an unacclimatized individual ascending rapidly to a high altitude. It is characterized by sudden onset of a bitemporal headache, nausea, fatigue, dizziness and can be life-threatening with the development of cerebral or pulmonary edema.

Acute Mountain Sickness is induced by this process: Radiation.

Presentation

Acute mountain sickness (AMS) is a common form of altitude sickness which affects between 10 to 80% of individuals climbing to high altitudes [1] [2] [3] [4] [5]. Symptoms are variable and usually commence within 24 hours of an unacclimatized individual ascending rapidly to altitudes > 8000 feet. Common symptoms include headaches, dizziness, vomiting, anorexia, fatigue, and insomnia [6] and they are due to the hypoxic and hypobaric environment at high altitudes [7]. Other symptoms like loss of appetite, light-headedness, lassitude, dyspnea and delirium may also be present. Some patients experience worsening of symptoms with the development of either cerebral edema (HACE - high altitude cerebral edema) and/or high altitude pulmonary edema (HAPE). But in a majority of the cases, the symptoms of AMS usually improve after a day unless the patient ascends again to a higher altitude, in which case the symptoms can worsen.

Skin
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  • cardiovascular
    Tachycardia
    • What are the late symptoms of acute mountain sickness (1) Facial flushing/Irritability (2) Difficulty concentrating/Vertigo (3) Tinnitus/Visual and Auditory disturbances (4) Anorexia/Insomnia (5) Increased dyspnea/Weakness on exertion (6) Palpitations/Tachycardia[quizlet.com]
    • Subjective benefits include improvement in sleep habits, tolerance to cold; decreased dyspnea, anginal symptoms and tachycardia and improved appetite, all of which are symptoms associated with high altitude illness.[clinicaltrials.gov]
    • Symptoms include the following: Dyspnea at rest Cough Weakness or decreased exercise performance Chest tightness or congestion Signs include the following: Rales or wheezing in at least 1 lung field Central cyanosis Tachypnea Tachycardia A chest radiograph[emedicine.medscape.com]
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  • gastrointestinal
    Nausea
    • Symptoms of mild AMS include: mild to severe headache; nausea; vomiting; lack of appetite; lack of energy; altered balance and coordination; dizziness.[bigislandhikes.com]
    • […] mountain sickness - nausea and shortness of breath experienced by mountain climbers above ten thousand feet[thefreedictionary.com]
    • Symptom Score Headache none at all 0 mild headache 1 moderate headache 2 severe incapacitating headache 3 Gastrointestinal symptoms good appetite 0 poor appetite or nausea 1 moderate nausea or vomiting 2 severe nausea or vomiting 3 Fatigue/weakness Not[christopherimray.co.uk]
    • : altitude sickness that is experienced usually within several hours to one day of ascending above 8000 to 10,000 feet (about 2500 to 3000 meters) and that is marked by headache, nausea, loss of appetite, vomiting, insomnia, dizziness, and fatigue, and[merriam-webster.com]
    • Stay alert for acute mountain sickness symptoms such as headaches and nausea.[grindtv.com]
    Vomiting
    • : altitude sickness that is experienced usually within several hours to one day of ascending above 8000 to 10,000 feet (about 2500 to 3000 meters) and that is marked by headache, nausea, loss of appetite, vomiting, insomnia, dizziness, and fatigue, and[merriam-webster.com]
    • Symptom Score Headache none at all 0 mild headache 1 moderate headache 2 severe incapacitating headache 3 Gastrointestinal symptoms good appetite 0 poor appetite or nausea 1 moderate nausea or vomiting 2 severe nausea or vomiting 3 Fatigue/weakness Not[christopherimray.co.uk]
    • What are the initial manifestations of acute mountain sickness (1) Headache (Severe and persistent) (2) Lassitude (3) Drowsiness/Dizziness (4) Chilliness/Nausea and vomiting (5) Facial pallor/Dyspnea and cyanosis What are the late symptoms of acute mountain[quizlet.com]
    • More serious symptoms of AMS include increased tiredness, severe headaches, vomiting, loss of coordination, shortness of breath and coughing fits.[mallatreknepal.com]
    • Symptoms of mild AMS include: mild to severe headache; nausea; vomiting; lack of appetite; lack of energy; altered balance and coordination; dizziness.[bigislandhikes.com]
    Loss of Appetite
    • : altitude sickness that is experienced usually within several hours to one day of ascending above 8000 to 10,000 feet (about 2500 to 3000 meters) and that is marked by headache, nausea, loss of appetite, vomiting, insomnia, dizziness, and fatigue, and[merriam-webster.com]
    • See a Health Care Provider Mild altitude sickness or acute mountain sickness: Symptoms may include: Fatigue Headache Loss of appetite Nausea Sleep problems Swelling of arms and legs Vomiting Weakness Severe altitude sickness, high-altitude pulmonary edema[webmd.com]
    • ACUTE MOUNTAIN SICKNESS Mild symptoms feels like a hangover / not feeling well: Headache Fatigue / Tiredness Nausea Shortness of Breath Loss of Appetite Disturbance in Sleep Dizziness 2.[peakfreaks.com]
    • Symptoms of mild AMS include mild headaches, increased breathing, rapid pulse, nausea, loss of appetite, lack of energy, and general malaise.[nps.gov]
    • Symptoms usually start 12-24 hours after arrival at altitude and include headache , dizziness , fatigue , shortness of breath, loss of appetite, nausea, disturbed sleep , and a general feeling of malaise.[medicinenet.com]
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  • respiratoric
    Dyspnea
    • What are the initial manifestations of acute mountain sickness (1) Headache (Severe and persistent) (2) Lassitude (3) Drowsiness/Dizziness (4) Chilliness/Nausea and vomiting (5) Facial pallor/Dyspnea and cyanosis What are the late symptoms of acute mountain[quizlet.com]
    • High-altitude pulmonary edema (HAPE) is a form of noncardiogenic pulmonary edema causing severe dyspnea and hypoxemia.[merckmanuals.com]
    • Subjective benefits include improvement in sleep habits, tolerance to cold; decreased dyspnea, anginal symptoms and tachycardia and improved appetite, all of which are symptoms associated with high altitude illness.[clinicaltrials.gov]
    • High-altitude pulmonary edema (HAPE) occurs most commonly two to three days after arrival at altitude and consists of dyspnea (difficulty breathing) with exercise, progressing to dyspnea at rest, a dry cough, weakness, chest tightness or congestion, and[hprc-online.org]
    • […] at rest, ("one can no longer speak without gasping for breath "), and sometimes it eventually develops into life-threatening conditions (rare as high altitude pulmonary edema (HAPE) (fluid in the alveoli, with a dry cough that gets worse, fever and dyspnea[climbeverest.jimdo.com]
    Dyspnea at Rest
    • […] at rest, and chest tightness.[quizlet.com]
    • High-altitude pulmonary edema (HAPE) occurs most commonly two to three days after arrival at altitude and consists of dyspnea (difficulty breathing) with exercise, progressing to dyspnea at rest, a dry cough, weakness, chest tightness or congestion, and[hprc-online.org]
    • […] at rest, ("one can no longer speak without gasping for breath "), and sometimes it eventually develops into life-threatening conditions (rare as high altitude pulmonary edema (HAPE) (fluid in the alveoli, with a dry cough that gets worse, fever and dyspnea[climbeverest.jimdo.com]
    • Life-threatening symptoms of altitude illness include the dyspnea at rest, wheezing, or crackles of high-altitude pulmonary edema (HAPE) or the altered mental status and ataxia seen in high-altitude cerebral edema (HACE).[journals.lww.com]
    • Symptoms include fatigue, severe dyspnea at rest, and cough that is initially dry but may progress to produce pink, frothy sputum .[en.wikipedia.org]
    Periodic Breathing
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  • neurologic
    Headache
    • RCT Prevention of High Altitude Headache.[bestbets.org]
    • Treat the headache before going any higher.[nps.gov]
    • Many people think it is normal to have a headache at altitude when in fact it is not, it is very rare.[climbing-high.com]
    • Symptom Score Headache none at all 0 mild headache 1 moderate headache 2 severe incapacitating headache 3 Gastrointestinal symptoms good appetite 0 poor appetite or nausea 1 moderate nausea or vomiting 2 severe nausea or vomiting 3 Fatigue/weakness Not[christopherimray.co.uk]
    • This assesses five symptoms associated with high altitude: headache (“no headache at all” to “worst headache ever”), nausea (1.[journals.plos.org]
    Dizziness
    • : altitude sickness that is experienced usually within several hours to one day of ascending above 8000 to 10,000 feet (about 2500 to 3000 meters) and that is marked by headache, nausea, loss of appetite, vomiting, insomnia, dizziness, and fatigue, and[merriam-webster.com]
    • […] light-headedness Not dizzy Mild dizziness Moderate dizziness Severe dizziness 0 1 2 3 Difficulty sleeping Slept as well as usual Did not sleep as well as usual Woke many times, poor sleep Could not sleep at all 0 1 2 3 A total score of 3 to 5 mild AMS[patient.info]
    • Mild symptoms include headache, loss of appetite, nausea, fatigue, insomnia and dizziness.[mallatreknepal.com]
    • The San Juan Snowcat skiing terrain is at dizzying heights of up to 13,250 feet (4,039 metres).[powderhounds.com]
    • Dizziness, nausea, headaches, and shortness of breath are a few symptoms of this condition.[healthline.com]
    Insomnia
    • : altitude sickness that is experienced usually within several hours to one day of ascending above 8000 to 10,000 feet (about 2500 to 3000 meters) and that is marked by headache, nausea, loss of appetite, vomiting, insomnia, dizziness, and fatigue, and[merriam-webster.com]
    • Some of the Colorado ski towns are also at high altitude so insomnia may affect seaside dwellers for the first couple of nights.[powderhounds.com]
    • […] defined acute mountain sickness as the presence of headache in an unacclimatized person who has recently arrived at an altitude above 2,500 m plus the presence of one or more of the following: gastrointestinal symptoms (anorexia, nausea, or vomiting), insomnia[clinicaltrials.gov]
    • At first the symptoms of acute mountain sickness are mild : the patient complains of headache, fatigue, loss of appetite, nausea, insomnia, dizziness and general malaise.[climbeverest.jimdo.com]
    • Signs of mountain sickness Early signs of acute mountain sickness include headache, nausea, loss of appetite and insomnia.[kalcounty.com]
    Irritability
    • It needs to be used cautiously, however, because it can cause stomach irritation, euphoria or depression.[peakfreaks.com]
    • […] of acute mountain sickness (1) Headache (Severe and persistent) (2) Lassitude (3) Drowsiness/Dizziness (4) Chilliness/Nausea and vomiting (5) Facial pallor/Dyspnea and cyanosis What are the late symptoms of acute mountain sickness (1) Facial flushing/Irritability[quizlet.com]
    • To recap, serious symptoms of altitude sickness include: A severe, enduring headache, which is not cured by ordinary painkillers Nausea and repeated vomiting Irritating dizziness or actual difficulty with balance and direction Visual disturbances with[mallatreknepal.com]
    • Mild acute mountain sickness If you have a mild case, you may experience: dizziness headache muscle aches insomnia nausea and vomiting irritability loss of appetite swelling of the hands, feet, and face rapid heartbeat shortness of breath with physical[healthline.com]
    • Preverbal children may develop loss of appetite, irritability, and pallor.[wwwnc.cdc.gov]
    Lethargy
    • Symptoms include headache, lethargy, shortness of breath, sleep disturbance, loss of appetite, nausea and vomiting and may lead to ataxia (unsteadiness), coma and death.[christopherimray.co.uk]
    • A severe headache, vomiting and lethargy will progress to unsteadiness, confusion, drowsiness and ultimately coma.[altitude.org]
    • In addition to AMS symptoms, lethargy becomes profound, with drowsiness, confusion, and ataxia on tandem gait test, similar to alcohol intoxication.[wwwnc.cdc.gov]
    • There may be confusion, changes in behaviour, or lethargy.[ratnavoyages.com]
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  • Face, Head & Neck
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  • Entire body system
    Fatigue
    • […] tired or weak 0 Mild fatigue/weakness 1 Moderate fatigue/weakness 2 Severe fatigue/weakness 3 Dizziness / lightheadedness none 0 mild 1 moderate 2 severe/incapacitating 3 Difficulty sleeping slept as well as usual 0 did not sleep as well as usual 1 woke[christopherimray.co.uk]
    • : altitude sickness that is experienced usually within several hours to one day of ascending above 8000 to 10,000 feet (about 2500 to 3000 meters) and that is marked by headache, nausea, loss of appetite, vomiting, insomnia, dizziness, and fatigue, and[merriam-webster.com]
    • However, increases in erythrocyte count, hematocrit and hemoglobin associated with EPO therapy have been shown to decrease fatigue and increase work capacity and exercise tolerance.[clinicaltrials.gov]
    • “my guts are really bad” to “my guts are fine”), fatigue (1.[journals.plos.org]
    • Moderate AMS : Moderate AMS includes severe headache (not relieved by medication), nausea, vomiting, increasing weakness and fatigue, shortness of breath, and decreased coordination.[medicinenet.com]
    Malaise
    • Symptoms of mild AMS include mild headaches, increased breathing, rapid pulse, nausea, loss of appetite, lack of energy, and general malaise.[nps.gov]
    • Symptoms usually start 12-24 hours after arrival at altitude and include headache , dizziness , fatigue , shortness of breath, loss of appetite, nausea, disturbed sleep , and a general feeling of malaise.[medicinenet.com]
    • It includes a constellation of symptoms, such as headache, loss of appetite, nausea, lightheadedness, a general feeling of malaise and difficulty sleeping.[sfgate.com]
    • At first the symptoms of acute mountain sickness are mild : the patient complains of headache, fatigue, loss of appetite, nausea, insomnia, dizziness and general malaise.[climbeverest.jimdo.com]
    • […] at least one of the signs and symptoms listed below: Lack of appetite, nausea, or vomiting Exhaustion or weakness Dizziness (light-headedness) Insomnia Pins and needles Panting (shortness of breath) upon exertion Feeling sleepy (drowsiness) General malaise[medicalnewstoday.com]
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  • Workup

    The clinician can diagnose AMS on the basis of the patient's clinical presentation, history, and physical examination findings. History will reveal recent ascent to high altitude by the unacclimatized patient while physical examination may reveal tachycardia, tachypnea, and pulmonary rales if the patient is developing pulmonary edema. Laboratory tests like complete blood count may be abnormal with elevated hematocrit, and erythrocytosis while arterial blood gas analysis will reveal respiratory alkalosis. Pulse oximetry values do not usually indicate the severity of AMS and are therefore not useful in either detecting or in the management of the condition although they may help to detect HAPE. An electrocardiogram may show variable features like right axis deviation, non-specific ST-T changes, sinus arrhythmias, and P wave abnormalities. Chest radiography is indicated only in patients suspected clinically to have HAPE.

    The diagnosis and severity of AMS can be assessed using the Lake Louise score (LLS) [8] as well as the Environmental Symptoms Questionnaire (ESQ) [9] [10]. The LLS was developed by a consensus conference on Hypoxia and Mountain Medicine in 1991 and consists of a self-reported score which is the sum of responses to five questions [8] and can be verified by a clinician during an interview. The ESQ consists of an inventory of expected physiological and psychological symptoms and was developed by the United States army. A part of this inventory containing symptoms indicative of cerebral hypoxia (AMS-C) is used to assess AMS [11]. However, the two questionnaires do not corroborate to provide an identical diagnosis [12] and as yet there is no gold standard tool for the assessment of AMS [13] [14].

    Despite the presence of AMS symptoms, magnetic resonance imaging does not detect brain edema or an increase in brain volume for up to 12 hours after hypoxia and is therefore not helpful in the diagnosis and management of AMS [14].

    Laboratory

    Serum
    Hypocapnia
    • Severe altitude illness occurs most commonly in this range. [8] Extreme altitude [ edit ] Above 5,500 metres (18,000 ft), marked hypoxemia, hypocapnia , and alkalosis are characteristic of extreme altitudes.[en.wikipedia.org]
    • The hypoxic ventilatory drive causes hypocapnia and a reduction in respiratory drive [11] .[journals.plos.org]
    • Changes in sleep state, as well as conflicting effects of hypocapnia and hypoxia on the peripheral chemoreceptors, lead to a destabilization of the respiratory control system, which is responsible for the periodic breathing observed at high altitude.[emedicine.medscape.com]
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  • ECG

    Rhythm
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  • Axis
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  • T Wave
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  • QT, RR, ST Intervals
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  • P Wave
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  • Treatment

    Prognosis

    Complications

    Pulmonary Hypertension
    • Reversal of high altitude pulmonary hypertension.[emedicine.medscape.com]
    • Even if N.M.S.U. tested all of the nearly one million cows grazing in the Rockies for pulmonary hypertension—high blood pressure in the lungs—it wouldn't solve the brisket problem.[livescience.com]
    • If you have lung disease, such as COPD, cystic fibrosis, pneumonia, pulmonary hypertension or sleep apnea, you should check with your doctor prior to travel to high altitude.[uptodate.com]
    • Sildenafil citrate for the prevention of high altitude hypoxic pulmonary hypertension: double blind, randomized, placebo-controlled trial.[journals.lww.com]
    • Bates MG, Thompson AA, Baillie JK, Sutherland AI, Irving JB, et al. (2011) Sildenafil citrate for the prevention of high altitude hypoxic pulmonary hypertension: double blind, randomized, placebo-controlled trial.[journals.plos.org]
    Hypoxia
    • In Hypoxia: The Adaptations (ed.[jeb.biologists.org]
    • The effects of hypoxia may be mild or even unnoticeable.[bodyandhealth.canada.com]
    • Hypoxia: The Adaptations .[emedicine.medscape.com]
    • What are the general considerations for acute mountain sickness (AMS) AMS is due to hypobaric hypoxia at high altitudes (greater than 6560 feet), usually as a result of increased physical activity with insufficient acclimatization, inaequate education[quizlet.com]
    • A low-pressure, low-oxygen exposure (hypobaric hypoxia) is an environmental stress that results from ascending to high altitude.[hprc-online.org]
    High Altitude Cerebral Edema
    • If a person has these symptoms at high altitude, you should assume that the person has high-altitude cerebral edema.[drugs.com]
    • However, Shah et al have described potential drugs for management of high-altitude illnesses, such as acute mountain sickness (AMS), high altitude cerebral edema, and high altitude pulmonary edema (HAPE) as one group under the section “Novel drug treatment[dovepress.com]
    • (See "Acute mountain sickness and high altitude cerebral edema" .)[uptodate.com]
    Cor Pulmonale
    • They concluded that patients with mild or moderate COPD without cor pulmonale tolerate altitude exposure quite well.[emedicine.medscape.com]
    Alkalosis
    • Severe altitude illness occurs most commonly in this range. [8] Extreme altitude [ edit ] Above 5,500 metres (18,000 ft), marked hypoxemia, hypocapnia , and alkalosis are characteristic of extreme altitudes.[en.wikipedia.org]
    Cerebral Edema
    • If a person has these symptoms at high altitude, you should assume that the person has high-altitude cerebral edema.[drugs.com]
    • However, Shah et al have described potential drugs for management of high-altitude illnesses, such as acute mountain sickness (AMS), high altitude cerebral edema, and high altitude pulmonary edema (HAPE) as one group under the section “Novel drug treatment[dovepress.com]
    • AMS is generally benign though may progress to high-altitude cerebral edema (HACE) in more severe cases or during continued ascent when symptoms of AMS are present.[link.springer.com]
    High Altitude Pulmonary Edema
    Pulmonary Edema
    • Symptoms of high-altitude pulmonary edema commonly appear at night and can worsen during exertion.[drugs.com]
    • High altitude pulmonary edema.[emedicine.medscape.com]
    • High-altitude pulmonary edema (HAPE) is a form of noncardiogenic pulmonary edema causing severe dyspnea and hypoxemia.[merckmanuals.com]
    Central Sleep Apnea
    Hypocapnia
    • Severe altitude illness occurs most commonly in this range. [8] Extreme altitude [ edit ] Above 5,500 metres (18,000 ft), marked hypoxemia, hypocapnia , and alkalosis are characteristic of extreme altitudes.[en.wikipedia.org]
    • The hypoxic ventilatory drive causes hypocapnia and a reduction in respiratory drive [11] .[journals.plos.org]
    • Changes in sleep state, as well as conflicting effects of hypocapnia and hypoxia on the peripheral chemoreceptors, lead to a destabilization of the respiratory control system, which is responsible for the periodic breathing observed at high altitude.[emedicine.medscape.com]
    Apnea
    • Sleep Apnea Syndromes .[emedicine.medscape.com]
    • Preexisting Medical Problems Travelers with medical conditions, such as heart failure, myocardial ischemia (angina), sickle cell disease, any form of pulmonary insufficiency or preexisting hypoxemia, or obstructive sleep apnea (OSA) should consult a physician[wwwnc.cdc.gov]
    • If you have lung disease, such as COPD, cystic fibrosis, pneumonia, pulmonary hypertension or sleep apnea, you should check with your doctor prior to travel to high altitude.[uptodate.com]

    Etiology

    Causes

    Hypoxia
    • In Hypoxia: The Adaptations (ed.[jeb.biologists.org]
    • The effects of hypoxia may be mild or even unnoticeable.[bodyandhealth.canada.com]
    • Hypoxia: The Adaptations .[emedicine.medscape.com]
    • What are the general considerations for acute mountain sickness (AMS) AMS is due to hypobaric hypoxia at high altitudes (greater than 6560 feet), usually as a result of increased physical activity with insufficient acclimatization, inaequate education[quizlet.com]
    • A low-pressure, low-oxygen exposure (hypobaric hypoxia) is an environmental stress that results from ascending to high altitude.[hprc-online.org]
    Alkalosis
    • Severe altitude illness occurs most commonly in this range. [8] Extreme altitude [ edit ] Above 5,500 metres (18,000 ft), marked hypoxemia, hypocapnia , and alkalosis are characteristic of extreme altitudes.[en.wikipedia.org]

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

    Self-assessment

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    References

    1. Gertsch JH, Seto TB, Mor J, Onopa J. Ginkgo biloba for the prevention of severe acute mountain sickness (AMS) starting one day before rapid ascent. High altitude medicine & biology. 2002;3(1):29–37.
    2. Honigman B, Theis MK, Koziol-McLain J, et al. Acute mountain sickness in a general tourist population at moderate altitudes. Ann Intern Med. 1993;118(8):587–92.
    3. Karinen H, Peltonen J, Tikkanen H. Prevalence of acute mountain sickness among Finnish trekkers on Mount Kilimanjaro, Tanzania: an observational study. High altitude medicine & biology. 2008;9(4):301–6.
    4. Maggiorini M, Buhler B, Walter M, Oelz O. Prevalence of acute mountain sickness in the Swiss Alps. BMJ. 1990;301(6756):853–5.
    5. Murdoch DR. Altitude Illness Among Tourists Flying to 3740 Meters Elevation in the Nepal Himalayas. J Travel Med. 1995;2(4):255–6.
    6. Barry PW, Pollard AJ. Altitude illness. BMJ. 2003;326(7395):915–9.
    7. Gallagher SA, Hackett PH. High-altitude illness. Emerg Med Clin North Am. 2004;22(2):329–55.
    8. Roach RC, Bartsch P, Hackett PH, Oelz O. The Lake Louise acute mountain sickness scoring system, in Hypoxia and Molecular Medicine. Queens City Press, Burlington, Va, USA, 1993; pp. 272–274.
    9. Kobrick JL, Sampson JB. New inventory for the assessment of symptom occurrence and severity at high altitude. Aviation Space and Environmental Medicine. 1979; 50: 9: 925–929
    10. Sampson JB, Kobrick JL. The environmental symptoms questionnaire: revisions and new filed data. Aviation Space and Environmental Medicine. 1980; 51: 9 (1): 872–877
    11. Beidleman BA, Muza SR, Fulco CS, Rock PB, Cymerman A. Validation of a shortened electronic version of the environmental symptoms questionnaire. High Altitude Medicine and Biology, 2007; 8 (3): 192–199.
    12. Wagner DR, Teramoto M, Knott JR, Fry JP. Comparison of scoring systems for assessment of acute mountain sickness. High Altitude Medicine and Biology. 2012; 13 (4): 245–251.
    13. Roach RC, Kayser B. Measuring mountain maladies. High Altitude Medicine and Biology. 2007; 8 (3): 171–172
    14. Bartsch P, Bailey DM, Berger MM, Knauth M, Baumgartner RW. Acute mountain sickness: controversies and advances. High Altitude Medicine & Biology. 2004; 5: (2): 110–124.

    • Acute mountain sickness and acetazolamide - EB Larson, RC Roach, RB Schoene - JAMA: the journal of the , 1982 - Am Med Assoc
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    • A potential role for free radical-mediated skeletal muscle soreness in the pathophysiology of acute mountain sickness. - DM Bailey, B Davies, IS Young, DA Hullin - Aviation, space, and , 2001 - ukpmc.ac.uk
    • A potential role for free radical-mediated skeletal muscle soreness in the pathophysiology of acute mountain sickness. - DM Bailey, B Davies, IS Young, DA Hullin - Aviation, space, and , 2001 - ukpmc.ac.uk
    • Accident prevention in competitive cycling - JG McLennan, JC McLennan - The American Journal of , 1988 - ajs.sagepub.com
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    • Acute mountain sickness - TS Johnson, PB Rock - New England Journal of Medicine, 1988 - Mass Medical Soc
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    • Acetazolamide and dexamethasone in the prevention of acute mountain sickness - SC Zell, PH Goodman - Western Journal of Medicine, 1988 - ncbi.nlm.nih.gov
    • Adult subacute mountain sickness—a syndrome of congestive heart failure in man at very high altitude - IS Anand, Y Chandrashekhar, HK Bali, PL Wahi - The Lancet, 1990 - Elsevier
    • Acute Mountain Sickness in Travelers Who Consulted a Pre‐Travel Clinic - M Croughs, A Van Gompel - Journal of travel , 2011 - Wiley Online Library
    • Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage - B Basnyat, JH Gertsch, PS Holck - altitude medicine & , 2006 - online.liebertpub.com
    • Regurgitation. P1054Echocardiographic and speckle tracking imaging of left ventricular adaptation to high altitude in chronic mountain sickness (Monge disease). A - M Altman, C Bergerot - European , 2012 - intl-ejechocard.oxfordjournals.org
    • Acute mountain sickness is associated with sleep desaturation at high altitude - KR Burgess, P Johnson, N Edwards, J Cooper - Respirology, 2004 - Wiley Online Library
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    • 25-to 30-nm virus particle associated with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission - LA SAWYER, JJ MURPHY, JE KAPLAN - American Journal of , 1988 - Oxford Univ Press
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    • A randomized trial of dexamethasone and acetazolamide for acute mountain sickness prophylaxis - AJ Ellsworth, EB Larson, D Strickland - The American journal of medicine, 1987 - Elsevier
    • Acute high altitude hypoventilation that resulted in hyperventilation following hyperoxic tests. - GR Zubieta-Calleja, G Zubieta-Castillo - reocities.com
    • Acute intermittent porphyria - AD Farrage - the-medical-dictionary.com
    • A neurogenic basis for acute altitude illness. - JA Krasney - Medicine and science in sports and exercise, 1994 - ukpmc.ac.uk
    • Acetazolamide or dexamethasone use versus placebo to prevent acute mountain sickness on Mount Rainier. - AJ Ellsworth, EF Meyer, EB Larson - Western journal of medicine, 1991 - ncbi.nlm.nih.gov
    • Controlled comparison of ginkgo biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers: the prevention of high altitude illness - JH Gertsch, B Basnyat, EW Johnson, J Onopa - Bmj, 2004 - bmj.com
    • Active bacterial myocarditis: a case report and review of the literature - F Haddad, G Berry, RL Doyle, P Martineau - The Journal of heart and , 2007 - Elsevier
    • Acne rosacea - AD Farrage - 66.197.58.78
    • Adult subacute mountain sickness—a syndrome of congestive heart failure in man at very high altitude - IS Anand, Y Chandrashekhar, HK Bali, PL Wahi - The Lancet, 1990 - Elsevier
    • Acute altitude sickness in females - CW Harris, JL Shields, JP Hannon - 1966 - DTIC Document
    • Adult subacute mountain sickness—a syndrome of congestive heart failure in man at very high altitude - IS Anand, Y Chandrashekhar, HK Bali, PL Wahi - The Lancet, 1990 - Elsevier
    • Chickenpox and multiple sclerosis: a case report. - M Rösener, J Dichgans, R Martin - Journal of neurology, , 1995 - ncbi.nlm.nih.gov
    • Acute mountain sickness in tourists with children at Lake Chungara (4400m) in northern Chile - FA Moraga, JD Osorio, ME Vargas - Wilderness & environmental medicine, 2002 - Elsevier
    • 2013 Intravenous Medications: A Handbook for Nurses and Health Professionals - BL Gahart, AR Nazareno - 2012 - books.google.com
    • ALTITUDE STRESS IN HEART DISEASE - JW Wahrenberger - dartmouth.edu
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    Symptoma
      • Hi, this is Symptoma.