High-altitude illness is a continuum of syndromes that includes the potential for death. Understanding how to prevent altitude illness and how to treat it if it occurs is fundamental to trip planning and is an important role of medical advisors to travelers. Gradual ascent, along with pharmacotherapy where indicated, are the mainstays of prevention. Travelers with certain chronic medical conditions may require additional pretravel counseling and preparation. Diagnostic recognition of the differing manifestations of high-altitude illness as well as recommendations on appropriate therapeutic options are discussed in detail.
You have flown into Cusco, Peru (3400 m) to join a tour group that plans to hike the Inca Trail to Machu Picchu. During the evening of your arrival, you attend a welcome dinner with your group, where you meet a 29-year-old female fellow traveler from Miami who also flew in earlier in the day. As she gets up to leave the dinner early, she says she has a mild headache and feels generally run-down. You wonder if you should be concerned for her...
You are on an expedition to trek Mount Kilimanjaro. You have limited time, so you decided to do the 5-day Marangu route. At the end of day 3, you arrive at Kibo Hut (4730 m). As you are settling in to sleep for the night, you notice a 57-year-old man, also on your trek, who is walking with an unsteady gait and is vomiting. The expedition lead guide is unable to communicate with medical command, and he asks you for advice. You consider the options but know there is only one good one...
While embarking on your own guided trek into the Mount Everest region, you run into a 45-year-old man who had arrived into the Tenzing-Hillary Airport in Lukla, Nepal (2860 m) a few hours prior. He appears to be struggling hauling his backpack. When you ask him if he needs assistance, he mentions that he flew from London into Kathmandu 2 days prior and states that he seems to have “caught a cold” during his travels. He appears short of breath and you notice he is coughing up pinkish-white sputum. You wonder if he has more than just a cold and whether you should intervene...
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Following are the most informative references cited in this paper, as determined by the authors.
1. “How many tourists visited Machu Picchu in 2018?“ 2019. Peru Telgraph. Accessed August 10, 2021. (News website)
2. Croughs M, Van Gompel A, Rameckers S, et al. Serious altitude illness in travelers who visited a pre-travel clinic. J Travel Med. 2014;21(6):403-409. (Prospective questionnaire; 401 subjects)
3. * Luks AM, Auerbach PS, Freer L, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. Wilderness Environ Med. 2019;30(4S):S3-S18. (Clinical practice guidelines) DOI: 10.1016/j.wem.2019.04.006
44. * Luks AM, Swenson ER. Travel to high altitude with pre-existing lung disease. Eur Respir J. 2007;29(4):770-792. (Review) DOI: 10.1183/09031936.00052606
47. * Flaherty GT, Kennedy KM. Preparing patients for travel to high altitude: advice on travel health and chemoprophylaxis. Br J Gen Pract. 2016;66(642):e62-e64. (Clinical guideline review) DOI: 10.3399/bjgp16X683377
48. * Mieske K, Flaherty G, O’Brien T. Journeys to high altitude--risks and recommendations for travelers with preexisting medical conditions. J Travel Med. 2010;17(1):48-62. (Clinical guideline review) DOI: 10.1111/j.1708-8305.2009.00369.x
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Keywords: acute mountain sickness, high-altitude illness, HAI, high-altitude cerebral edema, HACE, high-altitude pulmonary edema, HAPE, acclimatization, acetazolamide, dexamethasone, nifedipine, ascent, descent, Lake Louise, headache, ataxia, hypoxia, nausea, vomiting, dizziness, Gamow, respiratory, cardiovascular, sickle cell, Downx
Ninad A. Shroff, MD, FAAEM; Jerome Balbin, MD; Oluwaseun Shobitan, MD
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September 1, 2021
September 30, 2024
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