All about High Altitude Sickness
Going to high altitude? You are at risk
1.You leave the comforts of your daily livings.
2. Different climatic condition.
3.Your previous medical history might act as a predisposing factor.
High Altitude Sickness or Acute mountain Sickness (AMS)
-It is a syndrome complex of (a) headache (b) nausea (c) dizziness (d) sleeplessness and (d) fatigue. Off course, headache is the cardinal symptom.
-Nobody is immune to AMS above 2000 – 2500m.
-It is not related to physical fitness or gender.
-Early AMS feel exactly like alcohol hangover. It is also heralded by the feelings of deep inner chill or a sense of not being well.
-Late or advanced AMS denotes increase in severity of the above mentioned symptoms.
-A typical picture will be: a porter arrived at high altitude carrying a heavy load. Immediately, he goes in a corner of dark room and rests there covered with a blanket from head to toe. He doesn’t want any tea or snacks. He starts to throw up once in a while. When asked he says he has the worse headache as if somebody is hammering a nail into his forehead and he feels terrible. He is still huddled in the corner at dinner time. When friends bring him food, he does not even want to look at it. When asked, he says I want to go down.
-It not infected with, AMS could process to two fatal complications: (a) High Altitude Cerebral Edema (HACE), meaning swelling of the brain or water in the brain. (b) High Altitude Pulmonary Edema (HAPE), meaning water in the lungs.
-It is characterized by increasing headache and vomiting, staggering gait, altered consciousness and other neurological signs. It is thought to be the progression on AMS. The condition develops more rapidly in the night is someone with AMS, probably because of further decrease in ventilation during the night. This explains the common belief in our people that somebody with a bad headache should not go to sleep. This is true but what is equally important is that they should not remain in the same place either. This fact highlights the importance of keeping a high index of suspicion and making decisions about descent in the day and not waiting for the night or the next morning. The single most important test to detect HACE in somebody with AMS is the tandem gait teat where a person walks straight on a line in a hill to toe fashion. If he falls beyond the line, it is strongly suggestive of HACE. The person becomes comatose soon thereafter.
-It is indivisibly fatal unless interfered with.
-It is characterized by increasing breathlessness even at rest, productive cough and bluish discoloration of lips and tongue. The sputum may become blood tinged latter on. It usually strikes the second night onwards. The bluish discoloration is a late sigh and should not happen in the hands of good friends. One important thing about HAPE is that it can occur in a setting outside of AMS. People can have full blown HAPE without headache and other symptoms of AMS. Thus when conformed with the above signs and symptoms of HAPE, those should not be ignore or dismissed in the light of absence of headache. HAPE likewise seems to be a completely difference pathology
-It is invariably fatal unless interfered with.
Why does it (AMS) happen?
-All is because of low atmospheric pressure.
-Low atmosphere leads to low oxygen tension in the air which we inhale and causes a series of changes in the body which may lead to AMS. There is liking of flute from the blood stream into brain. The arteries of the lunges also constrict causing increase in presser in them which promotes fluid leakage into the lunges. These occur when our body does not get sufficient time to adapt to the change in pressure. Some people may be unable to adapt at all because of some abnormalities in their bodies foe e.g. absence on one pulmonary, the relative proportion of their brain and the skull etc.
What are the risk factors for AMS ?
-Rapid ascend is the main risk factor.
-Dehydration, airways infections, overexertion, sleeping pills, obesity and alcohol are other risk factors.
-Previous history of altitude sickness is the best predator of weather one would be stuck again.
-Non flexible itineraries, peer pressure, tough and stoic personality are some other risk factors.
-Excess chill and cold exposure is a known risk factor of HAPE.
So, what we do??
-AMS is preventable and treatable.
-Our body is a Machine. It always gives signs when it is malfunctioning. All we need to do is to listen our body and help not hinder its process.
-By slow ascend, we can digest the altitude, the process is called acclimatization. Here, our body gets sufficient time to adjust to the high altitude. It is prudent to take a rest day every third day with the rate of ascend not more than 400m per day after the altitude of 3000m. Climb high and sleep low is another of the dictums of altitude medicine. Moderate exertion on rest days is also recommended.
-People acclimatizing well will have increased dieresis which helps prevent fluid accumulating in the body.
-The process of acclimatizing can be accelerated by the use of a drug called acetazolamide (diamond) taken at a dose of 250mg twice daily (5 mg/kg for kids).
How do I know where I have AMS ??
All ailments in the heights are altitude sickness unless proved otherwise. The tendency to rationalize and altitude the initial symptoms or altitude sickness to something else must be avoided and discouraged.
There is ‘self assessment and scoring system ‘to help you know when you are with altitude sickness. It is called the Lake Louise scoring system. It is advisable that all use this to score oneself one in the morning and once in late afternoon. In this out of total 15 points, a score of 3 or more with headache plus any other symptoms denotes AMS. The severity is classified as:
3 to 6: mild AMS
7 to 9: moderate AMS
10 or more than 10: severe AMS
What is the treatment of AMS??
-The million dollar saying is ‘go down, go down and go down’.
-There is no magic altitude which you should descend. Go down to the place where you were comfortable before. This is usually about 300m (1000f) or more.
-Stay where you are and do not ascend if you have moderate AMS.
-If one is badly stuck, we could only “buy time’ for him/her to go down by the use of (a) inject able or oral steroid (dexamethasone at the dose of 4 to 8 mg 6 hourly), (b)oxygen, (c) diamox, (d) pressure bag (Gamow bag and (e) diuretics (drug which makes one pee)
-Nifedipine, a drug used commonly in hypertension could be used in a setting of HAPE at the dose of 10 mg three to four times per day.
-Diamox should be avoided in people who are allergic of sulfa drugs. The most common side effect is tingling of the hands and feet and the easy and the lips. Some might experience that the aerated drink taste flat. People may wake up sever time times in the night because of the diuretic effect.
-Gastritis is the commonest side effect with dexamethasone and can be effectively talked with the use of drugs like ranitidine.
-Breathing Oxygen reduces the effects of altitude illness.
-Ibuprofen is also effective at relieving altitude headache.
Remember, all there only buy time. One still needs to go down, go down and go down.
The following might help you to stay away from AMS and its complications.
Do at High Altitude
1. Listen your body
2. Drink plenty of safe warm water. (Around 3 liters per day). Dehydration predisposes to altitude sickness.
3. Let doctor know if you are taking any medicines.
4. Let the doctor know of your previous illness/ surgeries etc. (they might need to prepare the mediations accordingly.
5. Stay warm. Take it easy. Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
6. Accept your susceptibility to AMS
7. Be prepared to stay behind or return back earlier than the group if you have bad altitude sickness.
8. Understand that you are in an unprivileged situation and thing can be less than expected.
9. Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.
10. Leave a trekker behind in your group with someone who doesn’t speak the trekker language.
Don’t at high altitude.
1. Attribute headache, fatigue etc to cold weather or exertion
2. Over-exert yourself when you first get up to altitude.
3.Take and sedatives.
4.Try to just push yourself. Courage displayed at inappropriate occasions is foolishness, not bravery
5. Be tempted to drink alcohol. (One can drink while coming back, that is while descending.
6. Assume that you would be stuck the last.
7. Be very religious and tough. ‘Victory is not reaching g the top but coming back safe’.
8. Get frustrated.
9. Present late
10. Take classic baths. (Cold predisposes one to AMS, HAPE)