PHYSIOLOGIC VARIABLES ASSOCIATED WITH THE DEVELOPMENT OF ACUTE MOUNTAIN SICKNESS AT THE SOUTH POLE Thursday May 16, 2013 Aerospace Medical Association Chicago, IL MF Harrison, MD PhD 1,2 ; P Anderson, MD 1 ; A Miller, MSc 1 ; K O’Malley 1 ; M Richert, PhD 1 ; J Johnson, MSc 1 ; BD Johnson, PhD 1 1 Mayo Clinic, Rochester MN; 2 Henry Ford Hospital, Detroit MI Harrison et al, Physiologic variables associated with the development of acute mountain sickness at the south pole. Aviat Space Environ Med 2013; 84(4):426
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PHYSIOLOGIC VARIABLES ASSOCIATED WITH THE
DEVELOPMENT OF ACUTE MOUNTAIN SICKNESS AT THE SOUTH POLE
Thursday May 16, 2013Aerospace Medical Association
Chicago, IL
MF Harrison, MD PhD1,2; P Anderson, MD1; A Miller, MSc1; K O’Malley1; M Richert, PhD1;
J Johnson, MSc1; BD Johnson, PhD1
1Mayo Clinic, Rochester MN; 2Henry Ford Hospital, Detroit MI
Harrison et al, Physiologic variables associated with the development of acute mountain sickness at the south pole. Aviat Space Environ Med 2013; 84(4):426
I will discuss off-label use and/or investigational use in my presentation:
Albumin & Dexamethasone
Dr Bruce Johnson’s Funding:National Science Foundation, B-179-M
Mayo Clinic Center for Translational Science Activity (CTSA), Clinical Research Unit Grant Number 1 UL1 RR024150 from the National Center for Research Resources
Overview
• What we know about AMS• What we don’t know about AMS• Why our AMS study is different• What we did• What we found• What it means• Where do we go next
Altitude Illnesses
• Acute Mountain Sickness (AMS)– “…unpleasant but self-limiting and benign
syndrome…”1 – Most common form of altitude illness2,3
• 1850 – 2750m: 22%• >3000m: 42%
• High Altitude Cerebral Edema (HACE)– End stage of AMS4
– Highest rate of fatalities amongst altitude illnesses
• Specific to AMS1:– circulating levels of proinflammatory
cytokines• C-reactive protein (CRP); IL-6; IL-6 receptor
– accumulation of inflammatory cells in multiple organs in body
– vascular leakage1Eltzschig & Carmeliet, 2011
Further Support for Role of Inflammation
• Glucocorticoids used to treat AMS1-4
– Efficacy as compared to acetazolamide?
• IL-6 and CRP in high-altitude trekkers who develop AMS & HAPE5
– IL-6 correlated with SaO2
• Ibuprofen AMS incidence vs placebo, 3810m6
1Hackett & Roach, 2001; 2Barry & Pollard, 2003; 3Schoene, 2008; 4Luks et al, 2010; 5Bailey et al, 2004; 6Lipman et al, In Press
Conclusion
• In a population of healthy adults who were rapidly transported to altitude with minimal physical exertion, a comprehensive analysis suggests importance of:– Tissue inflammation– Oncotic pressures and fluid shifts
Acknowledgements
• We would like to thank:– The employees of the US Antarctic Program– Crary Lab– Jay O’Brien– Kent Bailey– Josh Mueller
• Funding was provided by – National Science Foundation, B-179-M – Mayo Clinic Center for Translational Science Activity
(CTSA), Clinical Research Unit – Grant Number 1 UL1 RR024150 from the National Center
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