High altitude illness

Case history #1

Four young men aged between 15 and 18 were attempting the Marangu route on the Tanzanian mountain Kilimanjaro (5895 m). The team set off late from the park entrance (1600 m) and took only 3 hours to jog to the Mandara Hut (2740 m) in order to avoid travelling in the dark. After a poor night's sleep, all 4 complained of a throbbing headache the following morning, together with loss of appetite, nausea, and tiredness.

Case history #2

On descending from the summit of the Argentinean mountain Cerro Aconcagua (6962 m), a 24-year-old female climber became increasingly tired and breathless. On arrival back at camp (5700 m) she began to cough up pink blood-stained sputum, and complained of pain in her chest. On examination she was found to have a respiratory rate of 44, a heart rate of 122, and an arterial oxygen saturation of 55%.

Other presentations

In addition to acute mountain sickness (AMS) and high-altitude pulmonary edema (HAPE), high-altitude cerebral edema (HACE) is an important clinical entity of high-altitude illness.

In the majority of HACE cases there will be a history of AMS that fails to respond to rest, fluids, and appropriate treatment. In some cases AMS is simply ignored. Unsteadiness and weakness tends to develop earliest, with visual disturbances becoming increasingly common as the condition progresses. Simple physical activities such as dressing, washing, and eating take longer to perform and are eventually neglected. The sufferer prefers to sleep. Subtle changes in behaviour and personality are sometimes noted by teammates during the early stages of the disease. Sufferers often deny the presence of symptoms and have little recollection of their experience following recovery. Occasionally, symptoms of AMS may be absent early in HACE and lead to a misdiagnosis such as dehydration, exhaustion, or even a hangover being made.