High altitude related illness

Last reviewed: 20 Feb 2023
Last updated: 14 Nov 2019

Summary

Definition

History and exam

Key diagnostic factors

  • headache
  • ataxia
  • change in mental state: for example, tired, irritable, confused, forgetful, irrational
  • abnormal tone, power, and reflexes
More key diagnostic factors

Other diagnostic factors

  • nausea, vomiting, and loss of appetite
  • fatigue and weakness
  • dizziness or lightheadedness
  • difficulty sleeping
  • visual disturbance
  • shortness of breath
  • cough with or without sputum
  • rales
  • peripheral edema
  • accentuated pulmonary second sound
  • pyrexia
  • elevated respiratory rate
  • elevated heart rate
  • low arterial oxygen saturation
  • cyanosis
  • urinary incontinence or retention
  • retinal hemorrhages and papilledema on fundoscopy
  • chest pain
  • cranial nerve palsies (III, IV, and VI)
  • visual and auditory hallucinations, seizures, tinnitus, vertigo, tremors, speech disturbance, and deafness
Other diagnostic factors

Risk factors

  • high altitude
  • rapid ascent
  • low-altitude residence
  • history of previous altitude illness
  • younger age
  • exertion
  • poor awareness of high-altitude illness prior to travel
More risk factors

Diagnostic investigations

Investigations to consider

  • arterial blood gases
  • chest radiography
  • ECG
  • chest ultrasound and echocardiography
  • WBC count
  • lumbar puncture
  • CT head
  • MRI head
More investigations to consider

Treatment algorithm

INITIAL

high-altitude ascent planned

ACUTE

AMS

HAPE only

HACE only

concurrent HAPE and HACE

Contributors

Authors

Jeremy S. Windsor, MBChB, DCH, FCARCSI

Specialist Registrar

Anaesthetics and Intensive Care Medicine

University College Hospital

London

UK

Disclosures

JSW is an author of a number of references cited in this topic.

David Hillebrandt, MBBS, MRCGP, FIMC RCS (Edin), MFTM RCPS (Glas), Dip Mt Med (UIAA and Leics)

General Practitioner

Mountain Medicine & Pre Hospital Care

Derriton House

Derriton

Holsworthy

Devon

UK

Disclosures

DH is paid to advise a commercial high altitude company. DH is a member of the FPHC RCS (Edin) Diploma of Mountain Medicine, and has received some expenses and an honorarium. DH is an unpaid medical advisor to the British Mountain Guides and British Mountaineering Council.

Peer reviewers

James S. Milledge, MBBS

Honorary Professor

Department of Physiology

University College London

London

UK

Disclosures

JSM declares that he has no competing interests.

Mike Grocott, MD

Senior Lecturer

Intensive Care Medicine

University College Hospital

London

UK

Disclosures

MG declares that he has no competing interests.

Haibo Wang, MD, PhD

Assistant Professor

LSU Health Sciences Center

Shreveport

LA

Disclosures

HW declares that he has no competing interests.

  • High altitude related illness images
  • Differentials

    • Asthma, acute exacerbation
    • Community-acquired pneumonia
    • Acute exacerbation of chronic heart failure (CHF)
    More Differentials
  • Guidelines

    • CDC health information for international travel (yellow book): the pre-travel consultation - altitude illness
    • Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update
    More Guidelines
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