Overview
The disease of central hypoxia is caused by insufficient adaptability to the environment when arriving at the plateau area.
Symptoms include headache, dizziness, palpitations, bruising of the skin and mucous membranes, dyspnea, unsteady walking and drowsiness.
The cause of the disease is the rapid arrival of the patient from the plains to the plateau area.
Treatment includes general treatment, oxygen therapy, medication, etc.
Definition
Plateau disease refers to a group of diseases mainly manifested by central hypoxia due to insufficient adaptation to the environment after arriving at the plateau from the plains.
Plateau is defined as an area with an elevation (distance from sea level) of more than 3,000 meters above sea level.
Compared with the plains, plateau areas have lower atmospheric pressure, thinner air, and lower oxygen content in the atmosphere, making them prone to hypoxia.
Epidemiology
The disease can occur in anyone.
Those who suffer from respiratory system diseases, cardiovascular system diseases, endocrine metabolic diseases, neurological diseases, and poor physical condition are prone to it.
Types
According to pathological changes
Acute plateau reaction: symptoms are produced, but there are no obvious pathologic changes.
Plateau pulmonary edema: pathological changes mainly include increased lung weight, congestion and edema.
Plateau cerebral edema: pathological changes mainly include congestion and edema of brain parenchyma and interstitium.
Chronic plateau disease: pathological changes mainly include enlargement of the right ventricle, thickening of the right ventricular wall, masking of the right ventricular cavity, dilatation of the right lower pulmonary trunk, and disappearance of elastic fibers of the pulmonary trunk.
Typing according to the course of the disease
Acute altitude sickness
According to the pathology can also be divided into acute plateau reaction, plateau pulmonary edema, plateau cerebral edema (neurogenic altitude sickness).
Chronic altitude sickness
Also known as Monge’s disease.
According to the pathology, it can also be divided into chronic altitude reaction, altitude erythrocytosis, altitude blood pressure change, altitude heart disease.
Causes
Causes
It is mainly caused by a lack of adaptation to the low atmospheric pressure, low partial pressure of oxygen, and cold environmental conditions after arriving at the plateau quickly from the plains.
Risk factors
The following factors can induce altitude sickness or increase the risk of altitude sickness.
Cold: lack of attention to warmth, low temperatures, etc.
Hunger: starvation due to improper diet.
Alcohol consumption: drinking large amounts of alcohol, which can also occur when drinking smaller amounts of alcohol.
Exertion: Exertion due to climbing, labor, etc.
Mental and psychological factors: adverse emotions such as tension, anxiety, and anger can increase the risk of the disease or trigger it.
Sleep deprivation: sleep deprivation due to staying up late, insomnia, etc.
Diseases: Suffering from respiratory diseases, cardiovascular diseases, neurological diseases, endocrine and metabolic diseases.
Pathogenesis
Low atmospheric pressure and low oxygen content in the plateau area cannot meet the oxygen demand of the human body, and hypoxia occurs in human tissues.
Nervous system: hypoxia may cause vasodilatation, increased intracranial pressure, and cerebral edema in severe cases.
Respiratory system: the stimulation of hypoxia will deepen and accelerate breathing, causing respiratory alkalosis; long-term in the hypoxic environment, pulmonary hypertension can occur.
Cardiovascular system: blood pressure and heart rate may increase after being stimulated by hypoxia; long-term exposure to hypoxia may cause structural and functional abnormalities of the right ventricle due to pulmonary hypertension.
Hematopoietic system: the effect of hypoxia may result in increased hematopoietic function and increased red blood cells and hemoglobin in the blood.
Symptoms
Acute Highland Disease
Acute altitude sickness
Symptoms often occur 6 to 24 hours after entering the plateau area, and most of them can be relieved after staying in the plateau area for 24 to 48 hours and disappear after a few days. Common symptoms are as follows.
Headache: mostly occurs in the bilateral frontal area.
Palpitations.
Chest tightness.
Shortness of breath: shortness of breath.
Anorexia.
Nausea.
Vomiting.
Dizziness.
Unsteady walking.
Purplish skin and mucous membranes may be present.
Highland pulmonary edema
Most often occurs within 2 to 4 days of rapid entry into a plateau area. May appear after acute plateau reaction.
Behaviors such as eating foods with high salt content, climbing too fast, overexertion, cold, developing respiratory infections, and taking sleeping pills can increase the risk of occurrence. Common symptoms are listed below.
Tachycardia.
Difficulty in breathing.
Dry cough.
Sit-up breathing: Difficulty or worsening of dyspnea when lying down, improves when sitting up straight.
Coughing up sputum: Sputum may be white or pink foamy.
Plateau cerebral edema
It is the more serious state of the disease and is relatively rare. It mostly occurs 1 to 3 days after entering high mountain areas. Common symptoms are as follows.
Headache: mostly severe, accompanied by vomiting.
Mental confusion: may be manifested as confused speech and abnormal reaction.
Ataxia: can be manifested as decreased sense of balance and unsteady walking.
Hallucinations: may be manifested by hallucinations, hallucinations, and so on.
Speech disorder.
Orientation disorder: inability to recognize the location and time.
Drowsiness: not easy to wake up after falling asleep.
Wooden stiffness: the body is as stiff as wood.
Coma.
Convulsions: convulsions occur throughout the body and there is a loss of consciousness.
Chronic altitude sickness
Chronic Plateau Reaction
Refers to an acute plateau reaction that lasts for more than 3 months and does not resolve, and the following symptoms may occur.
Headache.
Dizziness.
Insomnia.
Memory loss.
Lack of concentration.
Palpitations.
Shortness of breath.
Loss of appetite.
Dyspepsia.
Numbness of hands and feet.
Syncope: transient loss of consciousness that may resolve on its own after a few seconds or minutes.
High Plateau Erythrocytosis
Headache.
Dizziness.
Memory loss.
Insomnia.
Hemiparesis, slurred speech, numbness of the limbs, which may resolve on its own within 24 hours.
Purpling of the face.
Pestle fingers: thick fingertips.
Plateau blood pressure changes
Decreased blood pressure: may be less than 90/60 mmHg.
Elevated blood pressure: also known as plateau hypertension.
Headache.
Dizziness.
Exertion.
Insomnia.
Plateau Heart Disease
Palpitations.
Shortness of breath.
Chest tightness.
Cough.
Purplish skin and mucous membranes.
Dilatation of the jugular veins.
Lower extremity edema, etc.
Apnea or snoring during sleep.
Seek medical attention
Conditions requiring medical attention
Headache, dizziness, shortness of breath, dyspnea, confusion, hallucinations, purplish skin and mucous membranes after entering the plateau area, etc. should seek medical treatment promptly.
Suggested departments
Emergency Department.
Preparation
Emergency department visits can be made by registering directly with the doctor. Social security card and previous medical information can be replenished at any time during the visit. You don’t need to file a medical record for an out-of-town visit.
What questions the doctor may ask
What’s wrong?
How long has the discomfort lasted?
Are there any symptoms such as headache, dizziness, chest tightness, shortness of breath, palpitations, nausea, or vomiting?
How long has it been since you arrived in the highlands?
Have you had any chronic illnesses in the past?
What medications have you taken recently?
Have you been examined? What are the results?
Have you had any treatment? What kind of treatment? What is the effect of the treatment?
Are there any foods or medications that you are allergic to?
Questions you can ask your doctor
What causes altitude sickness?
What tests are needed?
Is it life threatening?
How is the treatment carried out?
What do I need to pay attention to in my daily life?
Diagnosis
Disease Diagnosis
Medical history
Experience of arriving at a plateau area from a plain area.
Clinical manifestations
Symptoms
Headache, dizziness, shortness of breath, dyspnea, drowsiness, hallucinations, memory loss, palpitations, and coma upon arrival in the plateau region.
Signs
Vital signs: elevated heart rate, deep and fast breathing, and decreased or increased blood pressure may occur.
Lung examination: Auscultation may show signs such as wet rales (sounds similar to small blisters bursting).
Neurologic examination: there may be signs such as decreased sense of balance, hallucinations, disorientation.
Laboratory tests
Routine blood tests: white blood cell count may increase in acute altitude sickness; red blood cell count, hemoglobin and hematocrit may increase in chronic altitude sickness.
Blood biochemistry: check liver function, kidney function, sodium ion, potassium ion, etc., can understand the health status.
Arterial blood gas analysis: check arterial pH, partial pressure of oxygen, partial pressure of carbon dioxide, oxygen saturation, etc., to clarify the severity of the disease or exclude other diseases.
Imaging tests
Echocardiography: It can check the function and structure of the heart, clarify the severity of the disease or exclude other heart diseases.
Chest X-ray: abnormalities can be seen in plateau pulmonary edema, which is used to determine the severity of the disease or to rule out other lung diseases.
Head CT, Magnetic Resonance Imaging (MRI): can clarify the structure of the brain and is used to determine the severity of the disease or to rule out other diseases.
Echocardiography: It can examine the structure and function of the heart, pulmonary artery, aorta, etc., and is used to determine the severity of the condition or to rule out other diseases.
Electrocardiogram
It can check the function of the heart, clarify the severity of the lesion, or exclude other heart diseases.
Lung function test
It can check the function of lung inspiration and expiration, and clarify the severity of the disease.
Differential Diagnosis
Acute Highland Reaction
It needs to be differentiated from the following diseases.
Motion sickness
Similarities: dizziness, nausea, vomiting.
Difference: Motion sickness is a disease caused by the abnormal function of the ear labyrinth, which mostly occurs when traveling by car, boat, airplane and other means of transportation, especially when the road is winding and bumpy, and can be gradually relieved after stopping for rest.
Acute gastroenteritis
Similarities: headache, dizziness, nausea, vomiting.
Differences: Acute gastroenteritis is an infectious disease of the stomach and intestines, mostly caused by unclean food and drink, with little change in altitude. Symptoms such as fever, abdominal pain, and diarrhea may also occur. It can be distinguished by blood and fecal tests.
Hypertension
Similarities: Headache, dizziness, nausea.
Differences: Hypertension is a disease of abnormally high blood pressure, and symptoms can occur in plain areas. It can be relieved by taking medication to control blood pressure. It can be differentiated by blood tests and arterial blood gas analysis.
Highland pulmonary edema
It needs to be differentiated from the following diseases.
Lung infection
Similarities: cough, sputum, shortness of breath, dyspnea.
Differences: Lung infection is an inflammatory disease caused by pathogen infection, and symptoms such as fever may also occur. It can be differentiated by blood test and chest X-ray.
Pulmonary embolism
Similarity: Chest tightness, shortness of breath, dyspnea.
Difference: Pulmonary embolism is a disease caused by obstruction of the pulmonary artery, and may cause symptoms such as chest pain. It can be differentiated by arterial blood gas analysis and chest CT.
Spontaneous pneumothorax
Similarity: Cough, shortness of breath, chest tightness, dyspnea.
Difference: Spontaneous pneumothorax is a disease in which the pleural cavity is connected to the atmosphere by rupture of the pleura, resulting in the lungs being pressurized and shrunken, which can be differentiated by chest X-ray examination, etc.
Bronchial asthma
Similarities: Coughing, coughing up sputum, shortness of breath, dyspnea.
Differences: Bronchial asthma is mostly an allergen-induced disease, and can be distinguished by pulmonary function tests, chest X-ray, and arterial blood gas analysis.
Plateau cerebral edema
It needs to be differentiated from the following diseases.
Stroke
Similarities: dizziness, headache, disorientation, speech disorder, coma, etc.
Differences: Stroke is a disease in which brain function is abnormal due to the blockage or narrowing of cerebral blood vessels, and hemiparesis may also occur. It can be distinguished by head CT, head MRI and other examinations.
Hypoglycemia
Similarity: dizziness, hallucinations, speech disorder, fainting, drowsiness, coma.
Differences: Hypoglycemia is a condition in which blood sugar is below the lower limit of normal and occurs mostly in people with diabetes. It can also be characterized by irritability, emotional instability, profuse sweating, and darkness before the eyes. It can be differentiated by blood biochemistry (glucose) tests, etc.
High Plateau Erythrocytosis
It needs to be differentiated from the following diseases.
True erythrocytosis
Similarity: Increased blood erythrocytes.
Differences: Erythropoiesis is a disease of abnormal hematopoietic function. Splenomegaly, increased white blood cell count, increased platelet count, etc. can be seen, which can be differentiated from the following disorders: routine blood tests, abdominal ultrasound, etc.
Myelogenous Hematopoietic Abnormalities Syndrome
Similarity: Increase in blood erythrocytes.
Difference: Myelopoietic dyshematopoietic syndrome is a syndrome caused by abnormal function of bone marrow, which may also result in elevated or lowered white blood cell counts and elevated or lowered platelet counts. It can be differentiated by routine blood tests, peripheral blood smears, and bone marrow pathology.
Treatment
Aims of treatment: to improve hypoxia, relieve symptoms, protect heart, brain, lungs and other organ functions, and avoid serious conditions.
Treatment methods: general treatment, oxygen therapy, drug treatment, etc.
General treatment
Rest
Stop activity and sit or lie down to rest.
Keep warm while resting and stay away from cold and humid environment.
Eat appropriately
Eat properly if there is no nausea or vomiting.
Choose foods that are high in calories and easy to absorb and digest, such as sugary chocolates.
Change of venue
If symptoms are not relieved or worsened, move to an area with lower altitude.
The altitude should be lowered at least 300 meters in case of plateau reaction, at least 600 meters in case of acute plateau cerebral edema, and below 3,000 meters in case of acute plateau pulmonary edema. Chronic plateau disease should be transferred to plain areas.
It is best to be carried by others during the transfer, avoid walking, and pay attention to keeping warm.
Emotional relief
Improve mood, avoid tension and anxiety.
Exercise in moderation
In chronic highland disease, moderate exercise can be used to improve the body’s ability to tolerate hypoxia, and you can consult your doctor for specific exercises.
Oxygen therapy
Oxygen therapy is one of the main treatments for this disease.
In acute plateau reaction, oxygen can be inhaled by nasal catheter or mask, and the oxygen flow rate is 1~2L/min.
In acute plateau pulmonary edema, oxygen should be inhaled by mask, oxygen flow rate is 6～12L/min, oxygen concentration is 40%～50%.
When acute plateau cerebral edema, also take face mask oxygen absorption, oxygen flow rate is 2～4L/min, oxygen concentration is also 40%～50%.
In chronic plateau disease, low-flow oxygen is taken at night, and the oxygen flow rate is 1～2L/min.
Medication
Improvement of symptoms
When used for acute plateau reaction, it can relieve symptoms such as headache, nausea and vomiting.
Medications that may be used include aspirin, acetaminophen, ibuprofen, and prochlorperazine.
Lowering intracranial pressure
When used for cerebral edema, it promotes the movement of water from the brain tissue into the bloodstream, lowering intracranial pressure and preventing serious conditions such as brain herniation.
Commonly used drugs include mannitol.
Often combined with diuretic drugs.
Diuretic
It can promote the elimination of water from the body and relieve pulmonary edema and cerebral edema.
Commonly used drugs are furosemide, etc.
Hormone
It can improve the permeability of blood vessels and relieve bronchial spasm.
Commonly used drugs include adrenocorticotropic hormone, etc.
Improvement of central nervous system excitability
Improves respiratory function by increasing the degree of central excitation.
Commonly used drugs include santonin hydrochloride, niclosamide, etc.
Improve circulatory function
Nifedipine: can reduce pulmonary artery pressure and improve hypoxia.
Aminophylline: it can relieve bronchospasm, enhance heart function, promote urinary excretion, and reduce pulmonary artery pressure.
Other treatments
Bloodletting treatment: It is useful for chronic altitude sickness. It can only be used as a temporary treatment measure.
Prognosis
Cure
Most acute altitude reactions are self-curing.
Most other types of altitude sickness can be cured by lowering the altitude or by taking therapeutic measures such as oxygen intake.
Hazards
Headache, dizziness, shortness of breath, memory loss, insomnia, difficulty in breathing and other symptoms can occur, affecting life.
Acute pulmonary edema and acute cerebral edema occur and can be life-threatening if not treated in time.
Daily life
Daily life
Improve diet
Ensure a nutritious and balanced diet.
Ensure adequate protein, unsaturated fat, vitamins, minerals, dietary fiber, and water. Choose beans, milk, meat, fish, fresh fruits, fresh vegetables and nuts.
Appropriate control of carbohydrate intake, can choose cereals, potatoes, etc. instead of refined rice, refined noodles.
Avoid high salt and high fat diets, keep the daily salt consumption within 6 grams, and avoid fried, pickled and barbecued foods.
Adults should drink 1,500 to 1,700 milliliters of water daily, or control the amount of water according to the doctor’s requirements.
Avoid raw, cold, hard and hot food, chew slowly and avoid hunger and overeating.
Improve lifestyle habits
Quit smoking and stay away from second-hand smoke (avoid passive smoking).
Ensure adequate sleep and avoid staying up late.
Exercise moderately and choose exercise programs according to your doctor’s instructions.
The intensity of exercise should be gradual, avoid over-exercise.
If you feel unwell during exercise, stop immediately and take a rest.
Emotional relief
Avoid bad emotions such as tension, anxiety, anger and depression.
Relieve stress by listening to soft music, chatting with friends and relatives, reading books and watching soothing movies and TV dramas.
Safety
Stop and rest immediately to avoid falling.
If you experience unsteady walking or weakness, you should be accompanied by others when you go out, or use a wheelchair to retreat.
Adhere to the treatment of the underlying disease
Follow your doctor’s instructions to avoid adding medication or stopping treatment on your own.
Regular review
Follow your doctor’s instructions for regular check-ups.
Seek medical advice if you feel unwell
If your symptoms do not improve or worsen, or if new symptoms appear, you should consult your doctor promptly.
Prevention
People with cardiovascular, cerebrovascular, respiratory or endocrine system diseases and poor physical fitness should avoid traveling to plateau areas.
Physical examination should be done before traveling to the plateau area, and if there is any abnormality, traveling should also be avoided.
Traveling to the plateau should gradually increase the altitude. When the altitude is above 2500 meters, the rise should not exceed 600 meters every 24 hours.
The following methods of prevention should be taken when entering the plateau:
Reduce physical activities and avoid exertion.
Ensure adequate and balanced nutrition and increase carbohydrate intake appropriately.
Prohibit the consumption of alcohol.
Pay attention to keep warm and avoid catching cold.
Ensure adequate sleep and avoid staying up late.
Regular oxygen intake.
Preventive measures such as subcutaneous injection of oxygen into the lumbar area and taking medication can be chosen according to the doctor’s requirements.
When you enter the plateau area and experience discomfort, you should stop your activities immediately and consult a doctor to avoid serious situations.