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Altitude Sickness
Altitude sickness, also known as acute mountain sickness (AMS), altitude illness, hypobaropathy, or soroche, is a pathological effect of high altitude on humans, caused by acute exposure to low partial pressure of oxygen at high altitude. It commonly occurs above 2,400 metres (8,000 feet). It presents as a collection of nonspecific symptoms, acquired at high altitude or in low air pressure, resembling a case of flu, carbon monoxide poisoning or a hangover. It is hard to determine who will be affected by altitude-sickness, as there are no specific factors that compare with this susceptibility to altitude sickness. However, most people can climb up to 2500 meters (8000 ft) normally.
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About the condition
Altitude Sickness
The pleasures of trekking in the world's highest mountain ranges cannot be overstated. Neither can the dangers. Altitude sickness can occur in some people as low as 8,000 feet, but serious symptoms do not usually occur until over 12,000 feet. Even then it is not the height that is important, rather the speed in which you ascended to that altitude.
Acute mountain sickness (AMS) is actually more common in fit young men because they are more likely to attempt a rapid ascent by racing up the mountain like some indestructible super hero! As a general rule, it is far safer (and more enjoyable) to avoid altitude sickness by planning a sensible itinerary that allows for gradual acclimatisation to altitude as you ascend, (you can race back down as fast as you like!).
High 2,500 to 4,000 metres or 8,000 to 13,000 feet
Very High 4,000 to 5,500 metres or 13,000 to 18,000 feet
Extremely High over 5,500 metres or 18,000 feet
What is High Altitude?
It is difficult to determine who may be affected by altitude sickness since there are no specific factors such as age, sex, or physical condition that correlate with susceptibility. Some people get it and some people don't because some people are more susceptible than others.
Most people can ascend to 2,500 metres (8,000 feet) with little or no effect. If you have been at that altitude before with no problem, you can probably return to that altitude without problems as long as you are properly acclimatised. If you haven't been to high altitude before, you should exercise caution when doing so.
The Causes of Altitude Sickness
The percentage of oxygen in the atmosphere at sea level is about 21% and the barometric pressure is around 1000mb (760 mmHg).
As altitude increases, the percentage remains the same but the number of oxygen molecules per breath is reduced. At 3,600 metres (12,000 feet) the barometric pressure is only about 630 mb (480 mmHg), so there are roughly 40% fewer oxygen molecules per breath so the body must adjust to having less oxygen.
In addition, the lower air pressure at high altitude can cause fluids to leak from the capillaries in both the lungs and the brain which can lead to a fluid build-up. Continuing on to higher altitude without proper acclimatisation can lead to the potentially serious, even life-threatening altitude sickness.
Acclimatisation
The main cause of altitude sickness is going too high too quickly. Given enough time, your body will adapt to the decrease in oxygen at a specific altitude. This process is known as acclimatisation and generally takes one to three days at any given altitude, e.g. if you climb to 3,000 metres and spend several days at that altitude, your body will acclimatise to 3,000 metres. If you then climb to 5,000 metres your body has to acclimatise once again.
Several changes take place in the body which enable it to cope with decreased oxygen: * The depth of respiration increases.
* The body produces more red blood cells to carry oxygen.
* Pressure in pulmonary capillaries is increased, "forcing" blood into parts of the lung which are not normally used when breathing at sea level.
* The body produces more of a particular enzyme that causes the release of oxygen from haemoglobin to the body tissues.
Cheyne-Stokes Respirations
Above 3,000 metres (10,000 feet) most people experience a periodic breathing during sleep known as Cheyne-Stokes Respirations. The pattern begins with a few shallow breaths and increases to deep sighing respirations then falls off rapidly even ceasing entirely for a few seconds and then the shallow breaths begin again. During the period when breathing stops the person often becomes restless and may wake with a sudden feeling of suffocation. This can disturb sleeping patterns, exhausting the climber. This type of breathing is not considered abnormal at high altitudes. Acetazolamide is helpful in relieving this periodic breathing.
Acute Mountain Sickness (AMS)
AMS is very common at high altitude. At over 3,000 metres (10,000 feet) 75% of people will have mild symptoms. The occurrence of AMS is dependent upon the elevation, the rate of ascent, and individual susceptibility. Many people will experience mild AMS during the acclimatisation process. The symptoms usually start 12 to 24 hours after arrival at altitude and begin to decrease in severity around the third day.
The symptoms of Mild AMS include: * Headache
* Nausea & Dizziness
* Loss of appetite
* Fatigue
* Shortness of breath
* Disturbed sleep
* General feeling of malaise
Symptoms tend to be worse at night and when respiratory drive is decreased. Mild AMS does not interfere with normal activity and symptoms generally subside within two to four days as the body acclimatises. As long as symptoms are mild, and only a nuisance, ascent can continue at a moderate rate. When hiking, it is essential that you communicate any symptoms of illness immediately to others on your trip.
High Altitude Pulmonary Oedema (HAPO)
HAPO results from fluid build up in the lungs. This fluid prevents effective oxygen exchange. As the condition becomes more severe, the level of oxygen in the bloodstream decreases, which leads to cyanosis, impaired cerebral function, and death.
Symptoms of HAPO include:- * Shortness of breath at rest
* Tightness in the chest, and a persistent cough bringing up white, watery, or frothy fluid
* Marked fatigue and weakness
* A feeling of impending suffocation at night
* Confusion, and irrational behaviour
Confusion, and irrational behaviour are signs that insufficient oxygen is reaching the brain. One of the methods for testing yourself for HAPO is to check your recovery time after exertion. In cases of HAPO, immediate descent of around 600 metres (2,000 feet) is a necessary life-saving measure. Anyone suffering from HAPO must be evacuated to a medical facility for proper follow-up treatment.
Have you, or someone you know, ever suffered from HAPO or HAPE (high altitude pulmonary oedema/edema)? Then join the "International HAPE Database" a registry of previous HAPE sufferers worldwide who might consider participating in future research studies. For more information, follow this link:- “International HAPE Registry”
High Altitude Cerebral Oedema (HACO)
HACO is the result of the swelling of brain tissue from fluid leakage.
Symptoms of HACO include:- * Headache
* Weakness
* Disorientation
* Loss of co-ordination
* Decreasing levels of consciousness
* Loss of memory
* Hallucinations & Psychotic behaviour
* Coma.
It generally occurs after a week or more at high altitude. Severe instances can lead to death if not treated quickly. Immediate descent of around 600 metres (2,000 feet) is a necessary lifesaving measure. There are some medications that may be used for treatment in the field, but these require proper training in their use.
Anyone suffering from HACO must be evacuated to a medical facility for follow-up treatment.
Notes about HACO and HAPO Also known as HAPE and HACE.
* Can come without any warning
* can develop rapidly over a period of hours
* Often start at night, although they can come on in the day
* There may be no preceding symptoms or warning
* Can affect people who have ascended previously to the same height without problems
* Can affect people who have followed the guidelines for acclimatisation
* Can affect people who are taking Diamox (acetazolamide)
* Can affect fit and unfit people and indigenous people including porters
Prevention of Altitude Sickness
This involves proper acclimatisation and the possible use of medications.
Emergencies requiring immediate descent
Two sets of symptoms requiring immediate descent:
1. Fluid on the lungs Showing up as struggling to breath, extreme fatigue, rattling breathing, coughing, blue or grey lips and fingernails, drowsiness, collapse, confusion and death. This condition is known as HAPE (High Altitude Pulmonary Oedema). The cardinal feature is extreme shortness of breath - being short of breath when everybody else has got their breath back.
2. Fluid on the brain Showing up as changes in behaviour, lethargy, and loss of coordination (unable to walk in a straight line). This can progress to coma and death. This condition is known as HACE (High Altitude Cerebral Oedema). The cardinal feature is cognitive impairment (inability to think straight and carry out normal tasks).
These two conditions are emergencies requiring immediate descent, even if this is in the night. The descent needs to be between 500-1,000 metres (1,500-3,000 feet) and as soon as is possible. Delay can be fatal.
In addition to descent, treatment includes oxygen, steroids and hyperbarric oxygen (oxygen delivered in a high pressure chamber).
About the Medicine
About Acetazolamide (Diamox)
Diamox increases the amount of urine produced and changes the acidity of the blood. The net effect is to improve breathing and reduce fluid around the brain and in the lungs.
Acetazolamide is not licensed to prevent and treat altitude sickness although it has long been used for this purpose.
Side Effects
Most patients using Diamox for short term treatment do not have any side effects.
Side effects reported include:
a 'tingling' feeling in the fingers and toes; some loss of appetite, taste disturbance, flushing, thirst, headache, dizziness, fatigue, irritability, and depression.
Uses of Acetazolamide (Diamox)
1. In the mild acute mountain sickness (headache, fatigue, light headedness, difficulty with sleep) symptoms resolve more quickly with Diamox (acetazolamide). The symptoms usually go by themselves in around 24-48 hrs. This reduces to around 12-24 hrs with Diamox.
2. Taking Diamox will reduce the likelihood of altitudue sicfkness in people who are forced to ascend without proper acclimatisation. Serious illness and even death are still possible. Diamox is not a substitute for acclimatisation.
3. Diamox improves the pattern of breathing during sleep at altitude and thus quality of sleep. During sleep at altitude the breathing pattern alters; rapid breaths are followed by prolonged pauses. This is not dangerous but tends to lead to poor sleep.
We do not recommend taking acetazolamide for people planning to undertake routine ascents. Most people who acclimatise properly do not need it. Taking Diamox (acetazolamide) can give a false sense of security.
Dosage
1. For the treatment of mild early acute mountain sickness (headache, fatigue, light headedness, difficulty with sleep): Diamox 250mg (one tablet) twice daily until symptoms resolve, when planned ascent can be resumed.
2. Where rapid ascent without proper acclimatisation cannot be avoided: Diamox 250mg (one tablet) twice daily. Continue for 2-3 days after final altitude is reached.
3. For disturbed breathing pattern during sleep: Diamox 125mg (half a tablet) twice daily. Continue until descent to an altitude where sleep is no longer a problem. Acetazolamide is not a sedative.
Important
Stopping Diamox does not cause a rebound in symptoms. The symptoms will not be worse than they would have been if Diamox (acetazolamide) had not been taken in the first place.
Taking Diamox (acetazolamide) for early symptoms does not mean it is OK to keep ascending. Do not ascend until symptoms resolve completely, usually 24-48 hrs.
Diamox (acetazolamide) does not mask serious underlying symptoms. It treats the cause not the symptoms. If a person feels better on Diamox (acetazolamide) it is because their condition has got better.
Treat altitude with respect. Do not imagine that a strong person can simply battle through. People who climb and hike in high places have a reputation for pushing themselves. When it comes to altitude; planning ahead, taking ones time and responding to ones own body are virtues.
Manufacturers and Brands
Goldshield Group Limited (Goldshield) is a marketing-led British Pharmaceutical and Consumer Health company. The company markets its products in more than 50 countries across the globe with primary focus in UK and EU markets. Goldshield has operational base in the UK, USA and India.
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Diamox (Acetazolamide) 250mg – 112 tablets
Acetazolamide is a carbonic anhydrase inhibitor. Carbonic anhydrase is a protein in your body. Acetazolamide reduces the activity of this protein.
Acetazolamide is use... read more. Size: 112 Max Quantity allowed to purchase: 1 Collect 41 points with this purchase!
£40.95 RRP: £67.99
Diamox (Acetazolamide) 250mg – 224 tablets
Acetazolamide is a carbonic anhydrase inhibitor. Carbonic anhydrase is a protein in your body. Acetazolamide reduces the activity of this protein.
Acetazolamide is use... read more. Size: 224 Max Quantity allowed to purchase: 2 Collect 40 points with this purchase!
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