Incidence and severity of acute mountain sickness and associated symptoms in children trekking on Xue Mountain, Taiwan

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Abstract

Background

Acute mountain sickness (AMS) occurs in non-acclimatized people after an acute ascent to an altitude of 2,500 m or higher. The aim of this study was to examine the incidence and severity of AMS and associated symptoms in children.

Methods

The prospective observational study included 197 healthy, non-acclimatized 11 and 12-year-old children trekking the round-trip from the trailhead to the summit of Xue Mountain, Taiwan (2,179 m to 3,886 m) over 3 days. AMS was evaluated at Qika Hut (2,460 m) on Day 1, at Sanliujiu Hut on Day 2 (3,100 m), and at the same altitude (3,100 m) after reaching the summit on Day 3. We used the Lake Louise Score (LLS) to diagnose AMS and record daily AMS-associated symptoms. We gave acetazolamide to children with mild to moderate AMS. Dexamethasone was reserved for individuals suffering from severe AMS. Acetaminophen was administrated to children with headache, and metoclopramide for those with nausea or vomiting.

Results

There were 197 subjects eligible for analysis. The overall incidence of AMS was 40.6%, which was higher in males and in subjects with a higher body mass index (BMI) ( p < 0.05). The prevalence of AMS on Day 1 was 5.6%, which was significantly lower than that on Day 2 (29.4%) and Day 3 (23.4%). The mean LLS of all subjects was 1.77 ± 2.08. The overall incidence of severe AMS (LLS ≥ 5) was 12.5%. The mean LLS of the AMS group (3.02 ± 2.46) was significantly higher than that of the non-AMS group (0.92 ± 1.16, p < 0.001). Among the AMS group, the mean LLS was 1.00 ± 1.55 on Day 1, 4.09 ± 1.97 on Day 2, and 3.98 ± 2.42 on Day 3. The most common symptom was sleep disturbance followed by dizziness, and headache. The prevalence of headache was 46.2% on Day 2 at 3,100 m, and 31.3% on Day 3 at the same altitude after climbing the summit (3,886 m). Males experienced significantly more headache and fatigue than females ( p < 0.05). The LLS and prevalence of all AMS symptoms were significantly higher in the AMS than the non-AMS group ( p < 0.05).

Conclusions

The AMS incidence among children trekking to Xue Mountain was 40.6%. AMS is common and mostly manifests as mild symptoms. Gender (male) and a higher BMI could be considered two independent risk factors of higher AMS incidence. Sleep disturbance is the most common symptom, and the lower prevalence of headache on Day 3 may be due to the effects of medication and/or acclimatization.

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Most cited references 30

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To determine the incidence of acute mountain sickness in a general population of visitors to moderate elevations, the characteristics associated with it, and its effect on physical activity. A cross-sectional study. Resort communities located at 6300 to 9700 feet elevation in the Rocky Mountains of Colorado. Convenience sample of 3158 adult travelers, 16 to 87 years old (mean age [+/- SD], 43.8 +/- 11.8 years). Twenty-five percent of the travelers to moderate elevations developed acute mountain sickness, which occurred in 65% of travelers within the first 12 hours of arrival. Fifty-six percent of those with symptoms reduced their physical activity. The odds favoring acute mountain sickness were 3.5 times as large for visitors whose permanent residence was below 3000 feet elevation as for those whose residence was above 3000 feet; 2.8 times as large for visitors with previous symptoms of acute mountain sickness; and twice as large in travelers younger than 60 years. Women, obese persons, those in poor or average physical condition, and those with underlying lung disease also had a higher occurrence of acute mountain sickness (P < 0.05). Acute mountain sickness occurs in 25% of visitors to moderate altitudes and affects activity in most symptomatic visitors. Persons who are younger, less physically fit, live at sea level, have a history of acute mountain sickness, or have underlying lung problems more often develop these symptoms.

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To assess the prevalence of symptoms and signs of acute mountain sickness of the Swiss Alps. A study using an interview and clinical examination in a representative population of mountaineers. Positive symptoms and signs were assigned scores to quantify the severity of acute mountain sickness. Four huts in the Swiss Alps at 2850 m, 3050 m, 3650 m, and 4559 m. 466 Climbers, mostly recreational: 47 at 2850 m, 128 at 3050 m, 82 at 3650, and 209 at 4559 m. In all, 117 of the subjects were entirely free of symptoms and clinical signs of acute mountain sickness; 191 had one or two symptoms and signs; and 158 had more than two. Those with more than two symptoms and signs were defined as suffering from acute mountain sickness. At 4559 m 11 climbers presented with high altitude pulmonary oedema or cerebral oedema, or both. Men and women were equally affected. The prevalence of acute mountain sickness correlated with altitude: it was 9% at 2850 m, 13% at 3050 m, 34% at 3650 m, and 53% at 4559 m. The most frequent symptoms and signs were insomnia, headache, peripheral oedema, and scanty pulmonary rales. Severe headache, vomiting, dizziness, tachypnoea, and pronounced pulmonary rales were associated with other symptoms and signs and therefore characteristic of acute mountain sickness. Acute mountain sickness is not an uncommon disease at moderately high altitude--that is, above 2800 m. Severe headache, vomiting, dizziness, tachypnoea, and pronounced pulmonary rales indicate severe acute mountain sickness, and subjects who suffer these should immediately descend to lower altitudes.

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Acute mountain sickness (A.M.S.) and its severe complications, high-altitude pulmonary oedema (H.A.P.O.) and cerebral oedema (C.O.), were studied in 278 unacclimatised hikers at 4243 m altitude at Pheriche in the Himalayas of Nepal. The overall incidence of A.M.S. was 53%, the incidence being increased in the young and in those who flew to 2800 m, climbed fast, and spent fewer nights acclimatising en route. It was unrelated to sex, to previous altitude experience, to the load carried, and to recent respiratory infections. The severity of A.M.S. was inversely related to age (independent of rate of ascent) and the highest altitude attained, and was highly ocrrelated with speed of ascent. There were 7 cases of H.A.P.O. and 5 with the more intractable C.O. and, of these 12, 11 had flown in, 9 had spent only one night at Pheriche, and none were on acetazolamide. 11 required evacuation. Acetazolamide, compared in a double-blind study with a placebo and also compared with no tablets at all, reduced both the incidence and the severity of A.M.S. in those who flew to 2800 m but not in those who hiked up to that altitude. Prevention consists in slow ascent, rapid recognition of warning signs, and prompt descent to avoid progression.

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Author and article information

Contributors

Fei-Ying Cheng: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: VisualizationRole: Writing – original draft

Mei-Jy Jeng: Role: Data curationRole: Formal analysisRole: Writing – original draft

Yin-Chou Lin: Role: Data curationRole: Formal analysis

Shih-Hao Wang:

ORCID: http://orcid.org/0000-0002-3072-3774

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Shih-Hao Wu: Role: Data curationRole: Formal analysis

Wen-Cheng Li: Role: Data curationRole: Formal analysis

Kuo-Feng Huang: Role: Data curationRole: Formal analysis

Te-Fa Chiu: Role: Data curationRole: Formal analysis

Gaurav Sikri: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 23 August 2017

Publication date Collection: 2017

Volume: 12

Issue: 8

Electronic Location Identifier: e0183207

Affiliations

[1 ] Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

[2 ] Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan

[3 ] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan

[4 ] Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan

[5 ] Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan

[6 ] Department of Recreation and Leisure Industry Management, College of Management, National Taiwan Sport University, Taoyuan, Taiwan

[7 ] Taiwan Wilderness Medical Association, New Taipei City, Taiwan

[8 ] Department of Emergency Medicine, Dalin Tzu Chi Hospital, Chiayi, Taiwan

[9 ] Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

[10 ] School of Medicine, Chang Gung University, Taoyuan, Taiwan

[11 ] Department of Health Management, Xiamen Chang Gung Hospital, Xiamen, China

[12 ] Department of Physical Education, National Taitung University, Taitung, Taiwan

[13 ] Department of Emergency Medicine, West Garden Hospital, Taipei, Taiwan

[14 ] Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan

[15 ] School of Medicine, China Medical University, Taichung, Taiwan

Armed Forces Medical College, INDIA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: mountainwangsh@ 123456gmail.com

Author information

Shih-Hao Wang http://orcid.org/0000-0002-3072-3774

Article

Publisher ID: PONE-D-16-29552

DOI: 10.1371/journal.pone.0183207

PMC ID: 5568320

PubMed ID: 28832689

SO-VID: 893d5895-795d-4e3f-8f84-1fd8a5e4e8e6

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 24 July 2016

Date accepted : 1 August 2017

Page count

Figures: 4, Tables: 2, Pages: 15

Funding

The author(s) received no specific funding for this work.

Custom metadata

Data Availability This study was approved by the Ethics Committee of Chang Gung Memorial Hospital. Because our participants are all children, the database contains patient privacy information, and participants and his/her parents did not consent to this form of data sharing. We are ethically and legally restricted according to the Human Subjects Research Act (Taiwan) from sharing data. However, we are able to provide data access to interested individuals pending Internal Review Board approval of individual data requests. Because the Ethics Committee of Chang Gung Memorial Hospital did not save the research data, future interested individuals may contact the corresponding author, Shih-Hao Wang ( mountainwangsh@ 123456gmail.com ) for queries and requests for data.