Acute Mountain Sickness

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.

  • Processes: Radiation
  • Incidence: 0 / 100.000

Overview

Etiology

Epidemiology

Pathophysiology

Prognosis

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.

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].

Treatment

Prevention

Patient Information

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: controversies and advances - P Bartsch, DM Bailey, MM Berger - altitude medicine & , 2004 - online.liebertpub.com
  • Altitude and the heart: Is going high safe for your cardiac patient? - JP Higgins, T Tuttle, JA Higgins - American Heart Journal, 2010 - Elsevier
  • 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 intermittent porphyria - AD Farrage - the-medical-dictionary.com
  • Acute mountain sickness and the edemas of high altitude: A common pathogenesis? - PH Hackett, D Rennie, RF Grover, JT Reeves - Respiration physiology, 1981 - Elsevier
  • A neurogenic basis for acute altitude illness. - JA Krasney - Medicine and science in sports and exercise, 1994 - ukpmc.ac.uk
  • 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
  • Acute altitude sickness in females - CW Harris, JL Shields, JP Hannon - 1966 - DTIC Document
  • 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
  • Acetazolamide in prevention of acute mountain sickness: a double-blind controlled cross-over study. - MK Greene, AM Kerr, IB McIntosh - British medical journal ( , 1981 - ncbi.nlm.nih.gov
  • Acute Mountain Sickness in Travelers Who Consulted a Pre‐Travel Clinic - M Croughs, A Van Gompel - Journal of travel , 2011 - Wiley Online Library
  • 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
  • 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
  • Acetazolamide in prevention of acute mountain sickness: a double-blind controlled cross-over study. - MK Greene, AM Kerr, IB McIntosh - British medical journal ( , 1981 - ncbi.nlm.nih.gov
  • 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
  • Acute mountain sickness - TS Johnson, PB Rock - New England Journal of Medicine, 1988 - Mass Medical Soc
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Acute mountain sickness and acetazolamide - EB Larson, RC Roach, RB Schoene - JAMA: the journal of the , 1982 - Am Med Assoc
  • Acute high altitude hypoventilation that resulted in hyperventilation following hyperoxic tests. - GR Zubieta-Calleja, G Zubieta-Castillo - reocities.com
  • Accident prevention in competitive cycling - JG McLennan, JC McLennan - The American Journal of , 1988 - ajs.sagepub.com
  • Acne rosacea - AD Farrage - 66.197.58.78
  • Acute medical problems in the Himalayas outside the setting of altitude sickness - B Basnyat, TA Cumbo - High altitude medicine & , 2000 - online.liebertpub.com
  • 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
  • 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