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How to overcome altitude illness

To people gasping for breath while climbing stairs, mountaineering etc what is the reprieve?

When asked this, Dr Sathyanarayanan of Sri Chakra Hospital in Chennai explained that lack of sufficient time for acclimatisation, increased physical activity and varying degrees of health may be responsible for the acute, subacute and chronic disturbances that result from hypoxia at altitudes greater than 2000 metres (6560 feet).

Marked individual differences in tolerance to hypoxia exist. Patients with sickle cell disease are at high risk of painful crises from altitude-induced hypoxemia (condition of having abnormally little oxygen in the blood).

What is acute mountain sickness?
The severity of acute mountain sickness correlates with altitude and rate of ascent.

Initial manifestations include headache (most severe and persistent symptom), lassitude, drowsiness, dizziness, chilliness, nausea and vomiting, facial pallor, dyspnea (Difficult or labored respiration) and cyanosis (a bluish discoloration of the skin and mucousmembranes; a sign that oxygen in the blood is dangerously diminished (as in carbonmonoxidepoisoning).

Later, there is facial flushing, irritability, difficulty in concentrating, vertigo, tinnitus (a ringing or booming sensation in one or both ears; a symptom of an ear infection or Ménière’s disease), amorexia, insomnia, increased dyspnea and weakness on exertion, increased headaches (due to cerebral edema), palpitation, tachycardia, Cheyne-Strokes respiration (abnormal respiration in which periods of shallow and deep breathing alternate) and weight loss.

More severe manifestations include pulmonary edema and encephalopathy. Voluntary period hyperventilation may relieve symptoms.

In most individuals symptoms clear within 24-48 hours, but in some instances, if the symptoms are sufficiently persistent or severe, the patient must be returned to lower altitudes.

Definitive treatment is immediate descent, which is essential if reduced consciousness, ataxia (inability to coordinate voluntarymuscle movements; unsteady movements and staggering gait) or pulmonary edema occurs. Administration of oxygen, 1-2L/min, will often relieve acute symptoms.

If immediate descent is not possible portable hyperbaric chambers can provide symptomatic relief depending on altitude and severity.

Acetazolamide 250 mg every 8-12 hours or dexamethasone 8 mg initially followed by 4 mg every 6 hours for as long as symptoms persist is the recommended therapy; they may be used together in severe cases.

Preventive measures include slow ascent - 300 metres (984 feet) per day - adequate rest and sleep the day before travel, reduced food intake and avoidance of alcohol, tobacco and unnecessary physical activity during travel.

Acetazolamide 250 mg every 8-12 hours, beginning the day before ascent and continuing for 48-72 hours at altitude, may be used as prophylaxis.

Dexamethasone 4 mg every 12 hours beginning on the day of ascent, continuing for 3 days at the higher altitude and then tapering over 5 days is an alternative.

What is acute high-altitude pulmonary edema?
This serious complication usually occurs at levels above 3000 metres (9840 feet). Early symptoms may appear within 6-36 hours after arrival at a high altitude area: incessant dry cough, shortness of breath disproportionate to exertion, headache, decreased exercise performance, fatigue, dyspnea at rest and chest tightness.

Later, wheezing, orthopnea and hemotysis may occur. Recognition of early symptoms may enable the patient to descend before incapacitating pulmonary edema develops, but strenuous exertion should be avoided.

An early descent of even 500 or 1000 metres may result in improvement of symptoms. Physical findings include tachycardia, mild fever, ,tachypnea, cyanosis, prolonged respiration and rales and rhonchi.

The patient may become confused or comatose and the clinical picture may resemble severe pneumonia.

The white count is often slightly elevated, but the erythrocyte sedimentation rate is usually normal. Chest x-ray findings vary from irregular patchy infiltration in one lung to nodular densities bilaterally or with transient prominence of the central pulmonary arteries.

Transient non-specific electrocardiographic changes, occasionally showing right ventricular strain may occur. Pulmonary arterial blood pressure is elevated, whereas wedge pressure is normal.

Sarnath	Latest page update: made by Sarnath , Feb 3 2008, 4:39 AM EST (about this update About This Update new story by sarnath - Sarnath 625 words added 1 image added view changes - complete history)
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