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“One small step
for man; one
giant leap for
mankind”
- Neil Armstrong, 1969.
-First man on the moon.

-First words spoken on the moon.

 RESPIRATION IN UNUSUAL
ENVIRONMENTS: I
HIGH ALTITUDE PHYSIOLOGY

By
Dr. M. Anthony David MD,
Professor of Physiology
 ALTITUDES & HEIGHTS
 Normally most people on earth stay at
around the Mean Sea Level (MSL)
 However, groups of people stay at higher
than normal attitudes.
 The Sherpas, a mountain tribe of
Himalayas live at around 5500 Meters
above MSL, normally.
 When people living around MSL go up to
higher altitudes, changes occur in their
physiology, especially in Respiration.
BAROMETRIC PRESSURE CHANGES
IN HIGH ALTITUDE
 As the altitude increases above the
sea level, the corresponding
atmospheric pressure decreases.
 The partial pressure of Oxygen also
decreases.
 The arterial Oxygen saturation levels
also decrease with increase in the
altitude.
ALTITUDE, PRESSURE & PO2
ALTITUDE BAROMETRIC PO2 IN AIR
(feet) PRESSSURE mm Hg
mm Hg
0 (MSL) 760 159

10,000 523 110

20,000 349 73

30,000 226 47

40,000 141 29

50,000 87 18
 EFFECT OF ALTITUDE ON
ARTERIAL O2 SATURATION
100
Art. Oxygen Saturation%

90

80 Breathing Pure
Oxygen
Breathing Air
70

60

50
23 50
Altitude(1000s of feet)
OXYGEN CYLINDERS
 CO2 & O2 Partial pressures in
Alveoli across altitudes
PLACE ALTITUDE BAROMETRIC PA CO2 PA O2
Mts. PRESSURE Mm Hg Mm Hg
mmHg
SEA 0 760 40 100
LEVEL
COLORADO 1800 620 36 79
SPRINGS
PIKE’S 4300 460 28 53
PEAK
EVEREST 6400 355 19 39
North Col.
EVEREST 9100 240 15 24
Summit
PARTIAL PRESSURES OF OXYGEN
 EFFECTS OF ACUTE EXPOSURE TO
HIGH ALTITUDE : breathing air
ALTITUDE PRESSURE Alv. Alv. Art
(ft) mmHg PCO2 PO2 O2
mmHg mmHg saturation

0 760 40 104 97
(40) (104) (97)
10,000 523 36(23) 67(77) 90(92)

20,000 349 24(10) 40(53) 73(85)

30,000 226 24(7) 18(30) 24(38)

VALUES IN BRACKETS FOR ACCLIMATIZED PEOPLE

EFFECTS OF ACUTE EXPOSURE TO HIGH
ALTITUDE: breathing pure Oxygen

Alt(Feet) Pressure Alveolar Alveolar Art O2

Mm Hg PCO2 PO2 satn%
0 760 40 673 100
10,000 523 40 436 100
20,000 349 40 262 100
30,000 226 40 139 99
40,000 141 36 58 84
50,000 87 24 16 15
 ACUTE EFFECTS OF HYPOXIA

 As the altitude increases, the

barometric pressure decreases.
 This causes a handicap which may
be:
• Appreciable
• Considerable
• Serious
• Causing Imminent Collapse
 ACCLIMATIZATION
 “Getting used to…”
 People remaining at high altitudes for
days, weeks or years become more
and more acclimatized to low PO2.
 This causes the hypoxia to cause
fewer deleterious effects on their
bodies.
 They can thus work harder at higher
altitudes without hypoxic effects.
 How does acclimatization occur?

 Increased :
• Pulmonary ventilation.
• Number of RBCs ( Hypoxia causes
excess erythropoiesis).
• Diffusing capacity of the lungs.
• Vascularity of the peripheral tissues
• Ability of the tissue cells to use Oxygen
despite low PO2.
 NATURAL ACCLIMATIZATION
 This occurs in people living from
their birth at high altitudes.
 Those living in the Andes &
Himalayan mountains, for instance.
 Acclimatization begins in them in
infancy.
 The chest size is greatly increased.
 Their hearts are considerably larger
than those of lowlanders
 ACUTE MOUNTAIN SICKNESS

 This is also called as “High Altitude

Pulmonary Edema.”
 This occurs in a small number of
lowlanders who ascend rapidly to high
altitudes.
 Begins from a few hours up to 2 days after
their ascent.
 Is serious and results in their death unless
they are given Oxygen or taken to a low
altitude.
 ACUTE MOUNTAIN SICKNESS :
SYMPTOMS & SIGNS
 Acute Cerebral Edema:
• Hypoxia causes cerebral vasodilatation
• Increases capillary pressure
• Causes fluid to leak out into the tissues
• This leads to cerebral edema causing:
 Severe disorientation
 Other cerebral dysfunctions
 ACUTE MOUNTAIN SICKNESS :
SYMPTOMS & SIGNS
 Acute Pulmonary Edema:
• Severe hypoxia causes Pulmonary
arteriolar constriction.
• In some areas it is more and causes
edema.
• This can extend progressively to other
areas of the lungs.
• Can be reversed within hours on Oxygen
therapy
 CHRONIC MOUNTAIN SICKNESS

 Seen in people who reside for long at high

altitudes.
 Red cell number and mass increases
exceptionally.
 Pulmonary arterial pressure becomes very
high.
 The heart becomes enlarged in the right
side.
 The peripheral arterial pressure begins to
fall
 Congestive Cardiac failure & death follows
 They need to be taken to low altitudes as
soon as possible.
 They recover in low altitudes within days or
weeks.
S
P
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P
H
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 WEIGHTLESSNESS IN SPACE

 Astronauts experience “weightlessness” or

“microgravity” during space travel.
 Physiological problems of weightlessness
include:
• Motion sickness in the first few days.
• Translocation of fluids in the body
• Diminished physical activity as no strength of
muscular contraction is required to oppose
gravity.
 PROLONGED STAY IN SPACE CAN
CAUSE
 Decrease in :
• Blood volume.
• Red cell mass.
• Muscle strength.
• Work capacity
• Maximal Cardiac Output
 Loss of
• Calcium & Phosphate from the bones.
• Bone mass.
 PROLONGED STAY IN SPACE

Most of the problems are prevented

by:
 Vigorous exercise programs while in

the space.
 Especially for prolonged stay in

space.