Altitude Sickness ( Information)

High Altitude Sickness (Acute Mountain Sickness)

High altitude sickness is a condition that can occur when our body is not adapting well to having less atmospheric pressure and oxygen at high altitudes. It typically affects individuals who are not acclimatized to high altitudes and can be potentially dangerous if progresses to more severe forms without treatment. Symptoms of altitude illness can begin to occur around 8000ft(2500m) but serious altitude illness is rare below 10000ft(3000m). The body tries to adapt to the lower amount of oxygen in the air by increasing the rate and depth of breathing so you breathe faster and deeper which tries to bring more oxygen into the body. An increase in the number of red blood cells (hemoglobin) occurs after staying longer at a high altitude.

Causes of Altitude Sickness

• Low Atmospheric Pressure: The decrease in atmospheric pressure is primarily due to the thinner air at high altitudes. Low atmospheric pressure at high altitudes has several effects on the human body and develops altitude illness. 
• Less Oxygen:  The primary factor in altitude sickness, oxygen pressure becomes thinner at higher altitudes. This leads to hypoxia, in this condition body tissues have inadequate oxygen.
• Rapid Ascent: Ascending to high altitude rapidly does not give your body enough time to adjust to the changing altitude and the reduced oxygen levels.

Stages of High Altitude

1. Acute mountain sickness (AMS)

(Mild symptom feels like hangover/not feeling well) Acute mountain sickness (AMS), is a very common illness affecting people trekking or mountaineering at high altitude

Symptoms:

• Headache: It is often the first symptom and is usually throbbing in nature
• Fatigue/ tiredness: feeling weak or tired despite minimal physical exertion.
• Dizziness: feeling unsteady or off balance
• Short of breath/respiration: Difficulty breathing or breathlessness, especially with physical activity.
• Loss of appetite: no interest in eating food
• Sleeping Disturbance: sleeplessness, insomnia.
• Nausea and Vomiting: Feeling sick, queasiness, throwing up

2. High Altitude Pulmonary Edema (HAPE)

Lung problems by water in the lungs.  High altitude pulmonary Edema (HAPE) is a progressive stage of AMS and is an accumulation of fluid in the lungs, leading to respiratory  distress

Symptoms:

• Increasing shortness of breath even at rest
• Elevate pulse rate
• Severe cough-dry (difficulty in cough)
• very tired- unusual fatigue while walking
• Blueness of face, lip, and fingernails means inability to transport oxygen into the blood.
• Nausea and vomiting
• Fever

3. High Altitude Cerebral Edema (HACE)

   (Mental/psychological problem water in the head)

    High Altitude Cerebral Edema (HACE) is a progressive stage of AMS and is an accumulation of fluid between the brain and skull.

Symptoms:

• Severe headache
• Nausea and vomiting
• Tired, lethargic and fatigue
• Lack of coordination (walking like a drunk)
• Hallucinations and confusion
• Altered mental status/loss of mental ability
• Vision problems (blurry or double)
• Drowsy, hard to wake, unconsciousness and coma

Tests for High Altitude Cerebral Edema (HACE)

• Heel–to–toe walking test:  The victim is asked to take 10 very small steps, placing the heel of one foot to the toes of the other foot as they go.
• Standing test: the victim stands with eyes closed, feet together and arms at their sides.
• Finger-nose test: With eyes closed, the victim repeatedly and rapidly alternates between touching the tip of the nose with an index finger.
• Mental arithmetic test: give the victim a mantel arithmetic test e.g. Subtract 7 from 100 or simply add   

Prevention of High-Altitude sickness

Prevention is better than cure.

For mild symptoms of AMS:

• Once you can stay at the same altitude to see and ascend symptoms have resolved completely.
• If symptoms persist or worsen at this altitude descent is required. Descent is the best medicine 
• Having a sensible itinerary is the most important way to avoid altitude sickness.
• Do not make rapid ascent (don’t go too fast to high)
• Properly hydrate your body (drink more fluid- water, soup, juice etc.)
• Avoid alcohol, caffeine, smoking 
• Eat a carbohydrate diet
• Climb higher sleep lower
• Acclimatization (make proper plans   above 3000m after a 1000m ascent stay one more night for acclimatization)
• Don’t carry heavy packs
• Don’t travel alone
• Watch for symptoms of mountain sickness in yourself and your travel partners.
• Have Fresh, hygienic  Foods 

Treatment

• Proper hydrate: (Drink plenty of water, soup, juice, and fluid)
• Rest: Avoid physical exertion
• Monitor A.B.C: (Airway, Breath way, Circulation) and vital signs
• Oxygen:  Supplemental oxygen is commonly used in the treatment of high-altitude sickness, particularly in more severe cases. It can provide relief by increasing the amount of oxygen available to the body and helping to alleviate the symptoms of hypoxia.

Diamox (acetazolamide): 

It is a drug commonly used in the prevention and treatment of altitude sickness, specifically acute mountain sickness (AMS). Acetazolamide is a carbonic anhydrase inhibitor that helps to reduce the symptoms of altitude sickness by increasing the body's ventilation and aiding in the acclimatization process

Here are some key points to know about Diamox (acetazolamide) and its use in altitude sickness:

Mechanism of action:

Diamox works by increasing the excretion of bicarbonate in the kidneys, which leads to an acidification of the blood. This acidification stimulates the respiratory system, causing faster and deeper breathing. This increase in ventilation helps to compensate for the reduced oxygen levels at high altitudes and improves oxygenation.

Prevention and treatment of altitude sickness:

Diamox is commonly prescribed to individuals who are travelling to high altitudes and are at risk of developing altitude sickness. It is usually started a day or two before ascending and continues at a high altitude. Diamox can help prevent or reduce the severity of Mountain Sickness.

Dosage:

The typical dosage of Diamox for altitude sickness prevention is 125 to 250 milligrams (mg) taken twice daily, starting 24 to 48 hours before ascent and continuing for the duration of the stay at high altitude. The dosage may vary depending on individual factors and should be determined by a healthcare professional.

Side effects:

Diamox can cause side effects such as frequent urination, tingling or numbness in the extremities, taste alterations, and mild gastrointestinal symptoms. Some individuals may also experience allergic reactions or more severe side effects. It is important to discuss potential side effects and any pre-existing medical conditions with a healthcare professional before starting Diamox.

Precautions and contraindications:

Diamox is not recommended for individuals with a known allergy to sulfa drugs, severe kidney or liver disease, or certain types of glaucoma. It should be used with caution in individuals with certain medical conditions such as electrolyte imbalances, respiratory disorders, or diabetes. Always consult a healthcare professional to determine if Diamox is appropriate for you.

Dexamethasone for HACE and Nifedipine for HAPE  

The use of dexamethasone and Nifedipine for altitude sickness should be determined by a healthcare professional familiar with high-altitude medicine. It is not recommended for self-administration without appropriate medical evaluation and supervision.

Call for help: For any kind of emergency cases that might arise during your trekking and climbing, rescue service might be needed.