Acute high-altitude illness
A substantial proportion of South Africa (SA)’s population lives at high altitude (>1 500 m), and many travel to very high altitudes (>3 500 m) for tourism, business, recreation or religious pilgrimages every year. Despite this, knowledge of acute altitude illnesses is poor among SA doctors. At altitude, the decreasing ambient pressure proportionally decreases available oxygen (hypobaric hypoxia). This triggers both immediate respiratory compensation and gradual acclimatisation that occurs over days to weeks. Rapid ascents to altitudes above 2 500 m can precipitate acute altitude illness, including acute mountain sickness (AMS) and high-altitude pulmonary and cerebral oedema (HAPE and HACE). The best preventive measure is gradual ascent (no more than 300 - 500 m increase in sleeping altitude per day, with additional rest days for acclimatisation for every 1 000 m altitude gain), although chemoprophylaxis may speed acclimatisation. In the field, AMS, HAPE and HACE are diagnosed clinically. The Lake Louise Score questionnaire is used to elicit symptoms of AMS, and can be supplemented by assessing clinical signs such as tachycardia, tachypnoea, crepitations or ronchi, and ataxia. The mainstay of treatment for all but mild AMS is rapid descent to lower altitudes, which can be facilitated by administration of oxygen and drugs, including acetazolamide, dexamethasone and nifedipine, or use of a portable hyperbaric chamber.
Copyright remains in the Author’s name. The work is licensed under a Creative Commons Attribution - Noncommercial Works License. Authors are required to complete and sign an Author Agreement form that outlines Author and Publisher rights and terms of publication. The Agreement form should be uploaded along with other submissions files and any submission will be considered incomplete without it [forthcoming].
Material submitted for publication in the SAMJ is accepted provided it has not been published or submitted for publication elsewhere. Please inform the editorial team if the main findings of your paper have been presented at a conference and published in abstract form, to avoid copyright infringement. The SAMJ does not hold itself responsible for statements made by the authors.
Previously published images
If an image/figure has been previously published, permission to reproduce or alter it must be obtained by the authors from the original publisher and the figure legend must give full credit to the original source. This credit should be accompanied by a letter indicating that permission to reproduce the image has been granted to the author/s. This letter should be uploaded as a supplementary file during submission.