Altitude illness

doi:10.1136/bmj.326.7395.915

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P W Barry, consultant paediatric intensivist (pwb1@le.ac.uk)a,
A J Pollard, senior lecturer in paediatric infectious diseasesb

^a Department of Child Health, University of Leicester, Leicester LE2 7LX
^b Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU

Correspondence to: P W Barry

Accepted 10 March 2003

Altitude illness is common in people ascending to more than 2500 metres, especially if the ascent is rapid. In most cases it will manifest as a mild, self limiting illness but in a few cases it will progress to more severe, life threatening forms. This article explains the symptoms and available treatments

As more people travel to high altitudes for economic or recreational purposes, altitude medicine has become increasingly important. Doctors may be asked to give advice to people planning an excursion to high altitudes or to help with patients while they themselves are travelling. Altitude illness should be anticipated in travellers to altitudes higher than 2500 metres, although for most it will be mild, and self limiting, and will not require the intervention of a doctor. Rarely altitude illness may progress to more severe forms, which can be life threatening. The best method of preventing altitude illness is to ascend slowly, allowing time for acclimatisation. The mainstay of treatment is descent, and drugs and other treatments should be used mainly to aid this.

Summary points

Altitude related illness is rare at altitudes below 2500 metres but is common in travellers to 3500 metres or more

The occurrence is increased by a rapid gain in altitude and reduced by a slow ascent, allowing time for acclimatisation

For most travellers, altitude related illness is an unpleasant but self limiting and benign syndrome, consisting chiefly of headache, anorexia, and nausea

More severe forms of illness including cerebral or pulmonary oedema may occur and may be fatal, particularly if not recognised

The treatment of altitude related illness is to stop further ascent and, if symptoms are severe or getting worse, to descend

Oxygen, drugs, and other treatments for altitude illness should be viewed as adjuncts to aid descent