High-Altitude Illness Death Investigation

Abstract

High altitude illness (HAI) is the current accepted clinical term for a group of disorders including acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE), which occur in travelers visiting high-altitude locations. High-altitude illness is due to hypobaric hypoxia, is not associated with age or physical conditioning, and mild forms are easily treated. High-altitude cerebral edema and HAPE are medical emergencies that are fatal if not promptly treated and fortunately are uncommon. The cause of most high-altitude fatalities is not related to HAI and can be easily distinguished from HACE and HAPE; however, other causes of death may have symptoms and physical findings that overlap with HAI, making postmortem diagnosis challenging. Fatalities due to HAPE and HACE are diagnoses of exclusion. Medical examiners and coroners who work in jurisdictions with high-altitude locations should be aware of the risk factors, physiology, pathology, differential diagnosis, and classification of HAI to accurately recognize HAI as a cause of death. Medical examiners who do not work in jurisdictions with high-altitude locations may be asked to evaluate deaths that occur overseas associated with high-altitude trekking and mountaineering activities.