Everyone who ascends to the 4,200-meter altitude of the summit of Mauna Kea will experience hypoxia. Most effects are considered normal physiological adjustments associated with ascent to high elevations. But there can be a remarkable range of responses. Typical consequences of hypoxia include increased respiration and heart rates, fluid release by the blood (edema), increased blood volume to the brain and lungs at the expense of the digestive and muscular systems, visual impedance (tunnel vision), and an increase in alkaline blood pH. These symptoms may or may not lead to Acute Mountain Sickness (AMS).
Observatory workers are trained to identify the symptoms and possible complications of altitude. However, visitors and temporary summit workers should also be aware of these symptoms. Lack of knowledge of some symptoms - tunnel vision, vertigo - can lead to irrational fears or panic that may exacerbate the situation. People may faint - which is not usually dangerous except for the risk of hitting sharp or blunt objects during the collapse.
One of the earliest effects of hypoxia is impairment of judgement - similar to mild intoxication. When visitors' stays are less than an hour, the hypoxic symptoms experienced are usually only a mild headache or slight disorientation. However, visits lasting more than an hour may lead to worse symptoms that may be indicative of the onset of AMS - and the person afflicted may not recognize the deterioration. Hence, it is critical to recognize any worsening in an individual's behavior or condition.
At altitude, a very common reaction is increased urinary output. The body's kidneys sense the lower level of oxygen immediately and kick into high gear. The kidneys release a hormone, erythropoetin, that commands the bone marrow to produce more red blood cells to increase the oxygen-carrying capacity of the blood. To make room for the increased red cells, the body dumps fluid from the blood - excess urine and collection of fluid in the body's tissues are two direct results of these biological actions. On initial ascent, the body dumps 10-15 percent of the blood supply's plasma. If a summit visitor were to become fully acclimatized, a process that would take two weeks of constant presence at altitude, the body's red-blood cell count would increase 30-50 percent.
The summit of Mauna Kea is very dry - humidity levels can fall to five percent or less. The mere act of exhaling expels moisture from the body. Hence, the combination of the kidney's activities and the dry air can lead rapidly to dehydration. It is imperative that a person drink water, juice or a Gatorade-type fluid at the summit to avoid dehydration. Some people have found the electrolytes in sports drinks (i.e., Gatorade, etc.) to be beneficial in maintaining proper balance in the blood chemistry. The slight headaches most people experience at the summit of Mauna Kea usually can be treated effectively with aspirin, Tylenol or Ibuprofen.
Symptoms of the onset of AMS can include worsening headache, nausea, fatigue, dizziness, acute tunnel vision, slurred speech, memory loss and/or combinations of these. Headache is the most common symptom experienced - it should be monitored closely as headaches can worsen rapidly. Children are much more susceptible to suffering from AMS. In adults susceptibility appears to be independent of age, sex or physical condition.
AMS results from the body's attempts to adjust to hypoxic stress; the effects usually occur within 2-6 hours after ascent and then disappear within 48 hours as the body becomes acclimatized to the altitude. Incidence and severity of AMS are affected by speed of ascent, previous acclimatization, altitude achieved and individual susceptibility. Twenty-five individuals going to the summit at the same time will have 25 different sets of responses; an individual going to the summit 25 different times will have 25 different sets of responses. Currently, there is no known method of predicting how your body will respond to altitude at any given time.
An additional blood-chemistry alteration that is common at altitude results from the decreased CO2 in the blood - due to increased respiration - which causes the blood-pH level to rise. This results in impaired oxygen transport and Cheyne-Stokes breathing, an irregular cycle of breath cessation and rapid breathing. The kidneys sense the higher pH levels, and begin the process of pulling bicarbonate from the blood. Inability to control blood pH is one of the primary factors in causing the onset of AMS.
Edema is one of the more serious symptoms of AMS. Edemas result from the body's blood supply dumping fluid (in order for the blood to carry more oxygen), with most of the fluid concentrating in the lungs and cranial cavity. This fluid build-up is often re-absorbed without ill effect.
Occasionally, fluid accumulates more rapidly than the body can absorb it. The result is pulmonary or cerebral edema: two very serious conditions. Pulmonary or cerebral edema can be fatal. Clinical studies have shown that at an altitude of 14,000 feet, 0.5 percent of adults and 8 percent of children under age 16 will suffer from pulmonary edema. Males and females are equally affected.
In high altitude pulmonary edema (HAPE), the lungs become waterlogged, thus increasing hypoxic symptoms to potentially critical levels, leading to respiratory failure. A very rapid resting heartbeat (tachycardia), very rapid breathing rate (tachypnea), chest pains (dyspnea) and cyanosis (blue skin) are early indications of HAPE.
High altitude cerebral edema (HACE) is the result of fluid release in the cranial space. Characteristics include intense headache, loss of coordination (ataxia), and loss of sensory ability (obtundation) which can lead to coma. HACE may progress very rapidly and is far more severe than HAPE. Early symptoms are weakness, disorientation, irrational behavior and hallucinations.
Although individuals unaccustomed to high altitude may experience more distress than those who have become acclimatized, this is not always the case. Non-acclimatized individuals may experience AMS early on, but more serious problems are unlikely to arise until after several days of exposure. Individuals who are already acclimatized are at risk for unusual and potentially lethal fluid accumulation in the lungs if they descend to sea level and then return rapidly to the summit. In effect, they lose their acclimatization and may not realize it.
Any abrupt change in symptoms should be taken as a warning sign that AMS may be accelerating toward one of these more dangerous conditions. Immediate application of oxygen and descent will usually correct the problem.
The early identification of potentially serious symptoms is essential to employee and visitor safety at the summit of Mauna Kea. In virtually all circumstances, serious complications can be averted and are usually reversible. When detection and prompt care are provided, AMS should not lead to permanent damage.
CARA employees who regularly work on the summit are required to pass a high-altitude medical exam. This is not a requirement for visitors or observing teams. Individuals who are pregnant or under the age of 16 are prohibited from visiting the observatory. It is highly recommended that individuals with histories of coronary, cerebral or respiratory disease check with their doctor before attempting to ascend to altitude.