Acute mountain sickness

Definition

Acute mountain sickness is an illness that can affect mountain climbers, hikers, skiers, or travelers at high altitudes, usually above 8000 feet (2400 meters).

Alternative Names

High altitude cerebral edema; Altitude anoxia; Altitude sickness; Mountain sickness; High altitude pulmonary edema

Causes

Acute mountain sickness is caused by reduced air pressure and lower oxygen levels at high altitudes.

The faster you climb to a high altitude, the more likely you will get acute mountain sickness.

The best way to prevent altitude illness is to ascend gradually. It is a good idea to spend a few days ascending to 9850 feet (3000 meters). Above this point ascend very slowly so that the elevation at which you sleep does not increase more than 990 feet to 1640 feet (300m to 500m) per night.

You are at higher risk for acute mountain sickness if:

You live at or near sea level and travel to a high altitude.
You have had the illness before.
You ascend quickly.
You have not acclimatized appropriately to the altitude.
Alcohol or other substances have interfered with acclimatization.
You have medical problems involving the heart, nervous system, or lungs.
If you have anemia

Symptoms

Your symptoms will also depend on the speed of your climb and how hard you push (exert) yourself. Symptoms range from mild to life-threatening. They can affect the nervous system, lungs, muscles, and heart.

In most cases, symptoms are mild. Symptoms of mild to moderate acute mountain sickness may include:

Difficulty sleeping
Dizziness or lightheadedness
Fatigue
Headache
Loss of appetite
Nausea or vomiting
Rapid pulse (heart rate)
Shortness of breath with exertion

Symptoms that may occur with more severe acute mountain sickness include the following and may progress to high altitude pulmonary edema or high altitude cerebral edema:

Blue color to the skin (cyanosis)
Chest tightness or congestion
Confusion
Cough
Coughing up blood
Decreased consciousness or withdrawal from social interaction
Gray or pale complexion
Inability to walk in a straight line, or walk at all
Shortness of breath at rest

Exams and Tests

The health care provider will examine you and listen to your chest with a stethoscope. This may reveal sounds called crackles (rales) in the lung. Rales may be a sign of fluid in the lungs.

Tests that may be done include:

Blood tests
Brain CT scan
Chest x-ray
Electrocardiogram (ECG)

Treatment

Early diagnosis is important. Acute mountain sickness is easier to treat in the early stages.

The main treatment for all forms of mountain sickness is to climb down (descend) to a lower altitude as rapidly and safely as possible. You should not continue climbing up if you develop symptoms.

Extra oxygen should be given, if available.

People with severe mountain sickness may need to be admitted to a hospital.

A medicine called acetazolamide (Diamox) may be given to help you breathe better. It can help reduce symptoms. This medicine can make you urinate more often. Make sure you drink plenty of fluids and avoid alcohol when taking this medicine. This medicine works best when taken before reaching a high altitude.

If you have fluid in your lungs (pulmonary edema), treatment may include:

Oxygen
A high blood pressure medicine called nifedipine
Beta agonist inhalers to open the airways
Breathing machine in severe cases
Medicine to increase blood flow to the lungs called phosphodiesterase inhibitor (such as sildenafil)

Dexamethasone (Decadron) may help reduce acute mountain sickness symptoms and swelling in the brain (cerebral edema).

Portable hyperbaric chambers allow hikers to simulate conditions at lower altitudes without actually moving from their location on the mountain. These devices are very helpful if bad weather or other factors make climbing down the mountain impossible.

Outlook (Prognosis)

Most cases are mild. Symptoms improve quickly when you climb down the mountain to a lower altitude.

Severe cases may result in death due to lung problems (pulmonary edema) or brain swelling (cerebral edema).

In remote locations, emergency evacuation may not be possible, or treatment may be delayed. This can have a negative effect on the outcome.

The outlook depends on how quickly the affected person can get to a lower altitude once symptoms begin. Some people are more prone to developing altitude-related sickness and may not respond as well as others.

Possible Complications

Complications may include:

Coma (unresponsiveness)
Fluid in the lungs (pulmonary edema)
Swelling of the brain (cerebral edema), which can lead to seizures, mental changes, or permanent damage to the nervous system
Death

When to Contact a Medical Professional

Contact your provider if you have or had symptoms of acute mountain sickness, even if you felt better when you returned to a lower altitude.

Call 911 or the local emergency number if you or another climber have any of the following symptoms:

Altered level of alertness
Coughing up blood
Severe breathing problems

Climb down the mountain right away and as safely as possible.

Prevention

Keys to preventing acute mountain sickness include:

Climb the mountain gradually. Gradual ascent is the most important factor in preventing acute mountain sickness.
Stop for a day or two of rest for every 2000 feet (600 meters) of climb above 8000 feet (2400 meters).
Sleep at a lower altitude when possible.
Make sure that you have the ability to rapidly descend if needed.
Learn how to recognize early symptoms of mountain sickness.

If you are traveling above 9840 feet (3000 meters), you should carry enough oxygen for several days.

If you plan on climbing quickly, or climbing to a high altitude, ask your provider about medicines that may help prevent acute mountain sickness, such as acetazolamide or dexamethasone.

If you are at risk for a low red blood cell count (anemia), ask your provider if your planned trip is safe. Also ask if an iron supplement is right for you. Anemia lowers the amount of oxygen in your blood. This makes you more likely to have mountain sickness.

While climbing:

Do not drink alcohol
Drink plenty of fluids
Eat regular meals that are high in carbohydrates

You should avoid high altitudes if you have heart or lung disease.

References

Basnyat B, Paterson RD. Travel medicine. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 79.

Cumpstey AF, Jackson AIR, Grocott MPW. Clinical care in extreme environments: physiology at high altitude and in space. In: Gropper MA, ed. Miller's Anesthesia. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 74.

Harris NS. High-altitude medicine. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 132.

Luks AM, Hackett PH. High altitude and preexisting medical conditions. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 3.

Luks AM, Schoene RB, Swenson ER. High altitude. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 105.