There are limits to acclimatization. Even those who are by nature good acclimatizers cannot tolerate the hypoxia of extreme altitude for long. Miners from South America report that they cannot live at altitudes above 5800 m because of weight loss, increasing lethargy, poor quality sleep, weakness, and headache. High altitude mountaineers cannot survive for more than a few days above 8000 m without supplemental oxygen because of more acute deterioration in physiologic functioning. Considerable weight loss, both of fat and lean body mass, are unavoidable at extreme altitude, and help contribute to demise. Other factors limiting ability to acclimatize to extreme altitude include right ventricular strain from excessive pulmonary hypertension, intestinal malabsorption, impaired renal function, polycythemia and microcirculatory sludging, and prolonged cerebral hypoxia. Even at more modest altitudes, some individuals are very slow or poor acclimatizers for reasons not entirely known but, at least in part, due to poor carotid body function and inadequate ventilation.
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