High Altitude Medicine

This article is made as a guideline for the high altitude medical information to some common altitude sicknesses. A traveller who wishes to travel at high altitude is required to know the actual cause the sickness and their possible solutions. This guideline may help to know the diseases, sickness or illness at a particular altitude and also to know the ways how one can avoid the unwanted situations.

Altitude profile

Type Altitude (ft.)
High 4,921 - 11,483
Very High 11,484 - 18,045
Extreme High >18,045

Oxygen Profile

Level Partial pressure of Oxygen Common disease
Sea Normal 160 mm of Hg
2500 m 26%lower than sea level Altitude sickness starts with
headache, body stress. Causing Hypoxia
4000 m 41% lower than sea level

The high altitude sickness generally occurred at an altitude more than 5,000 ft. from the sea level. The altitude sickness above 2,500 m is quite noticeable. The travellers need to be acclimatized their body to avoid the sickness. The High Altitude illness (HAI) includes mainly common Acute Mountain Sickness (AMS)and sometimes high-altitude pulmonary edema and rarely it is high altitude cerebral edema at this altitude.

The common symptoms of High Altitude Sickness or HAI:

  • The main symptom is headache (anorexia)
  • Causes nausea for some people
  • Vomiting may starts
  • Lethargy
  • Problem in sleeping (insomnia)
  • Low appetite
  • Like a mild Hangover
  • fatigue and lassitude
  • Anxiety and metal fatigue

The things which may influence HAI or AMS:

  • Continuous gaining of altitude above 2500 m
  • Body fitness
  • Hydration of the body
  • The effects change for different age and sex of the people
  • Previous history of getting HAI
  • Drinking alcohol at high altitude

To avoid the altitude sickness:

  • The best way to avoid is to acclimatize your body that is you should gain the higher altitude gradually.
  • Spend 2-3 days at 200-2500 m altitude then starts ascending.
  • Some aerobic exercise may help your body to be acclimatized quickly with the high altitude.
  • Try to sleep at lower altitude than the highest altitude that you gain at that particular day.
  • Hydrate the body with extra water.
  • Keeping uphill and downhill periodically in the high-altitude trek schedule.
  • If the symptoms of HAI increase with altitude or persist more than 2 days, then the best way to get out of it is to come down at lower altitude. Taking rest at lower altitude will help to acclimatize the body quickly.

To avoid the altitude sickness:

  • Acetazolamide (Diamox) can reduce the effect of mountain sickness efficiently. It is advisable to take extra water at night when you are taking Diamox because it helps to absorb water from stomach and makes blood pressure steady.
  • Dexamethasone[4 mg po/IM q 6 hours x 2 doses] and no farther ascend. It is not preferable to take this medicine during ascend.
  • Gingko balboa is another good medicine [120 mg po BID starting 5 days before ascend].
  • High doses of vitamin C sometimes work.
  • You can take some available anti-oxidant agent.
  • It is always advisable to consult with medical practitioner before taking any drug.
  • Give supplementary oxygen if possible.

At high altitude due to the inability of the body acclimatization, some fluid called excess fluid deposited or developed at the lung tissue. It is difficult to exchange the Oxygen gas properly through the Lung. The patient may feel breathing problem which causes the fatal disease HAPE. If immediate treatment is not started patient may die soon.

Symptoms of HAPE

  • Extreme fatigued and breathing problem starts
  • Difficult in balancing the body while walking
  • Chest tightness or congestion
  • Rapid heart bit rate at rest (90-100 bpm)
  • Dyspnea at rest
  • Breathlessness at rest
  • Fever at night
  • Symptoms will get worse at night
  • Lips and fingernails become blue or grey
  • Collapse
  • Coma
  • Sometimes breathing problem may occur due to Asthma. To avoid this confusion take immediate descent. If symptoms still have not improved then Asthma treatment is recomanded.

  • hape chest, dream wanderlust

The causes of HAPE

  • It is difficult to predict the HAPE with available knowledge database.
  • Sometimes it has been studied / observed that the HAPE patient has a past record of this kind of illness.
  • The person having common cold or chest infection before high ascend is at high risk.
  • If a person have had acute mountain sickness, then further ascend may cause the HAPE.

The treatment of HAPE

  • Immediate descent is strongly recommended. The HAPE patient may die within few hours, so urgent descent may save the life.
  • Nifedipine drug can be taken at the time of descending. But it is advisable to take help medical practitioner before taking the dose.
  • Hyperbaric treatment with quick descent givespromising result.
  • It has been seen that the quick descent with the drug treatment gives good result rather than taking drug at the same altitude.
  • Oxygen should be used for 5-10 hours as per requirements when the body is under rest.

High altitude cerebral edema (HACE) is considered as the fatal form of the acute mountain sickness. It is also considered as the potentially most dangerous illness as the brain stops working in the normal way. Within one hour it can quickly spread to the brain. So, one has to take care about the symptoms as it takes very short period of time to reach extreme condition. SometimesHACE patient dies before the treatment starts. The extreme case is coma for this kind of illness and it can kill a climber within one-three hours. Statistics say only 1% of the trekker get HACE when they are above 3000m.

Symptoms of HACE

  • Difficult to walk in a straight line
  • Vomiting
  • Hallucinations
  • Blindness
  • Body paralysis
  • Extreme fatigue
  • Unconsciousness
  • Coma
  • Irritations in behaviour

The causes of HACE

  • Continuous climb above 3000m ignoring the symptoms of acute mountain sickness.
  • The high blood pressure at low oxygen level causes leakage of blood flow inside the brain.
  • Blood vessels at the brain damaged with the excess pressure.

  • hace, dream wanderlust

Treatment of HACE

  • Like HAPE a quick descent is very much required.
  • Gamow bag and altitude chamber can be used as a temporary relief.
  • Oxygen treatment with immediate descent can work better.
  • Dexamethasonecan be taken for medication.
  • Hyperbaric Treatmentis also effective for this case.
Type of illness Common medicine
Acidity Gelucil
lampspro (Empty Stomach)
omaze (Empty Stomach)
alumag
Cold & nasal conjunction Levocetrizine
Levocetriwal
Alzene
Glencet
Lecope
acute mountain sickness Diamox(Acetazolamide 250mg)
Avva
Acetamide
Fever or body pain Dolo 650 (+antacid) - in empty stomach
ciprofloxacine 500
azithral
stomach acle/pain Meftalstas
loose motion Oflamacoz
Norfloxacine
Metronidazole
Asthma Deriphyllin
Delin tab CR
headache with body pain Combiflam(Ibuprofen)(Sanofi Aventis)
Ibugestic plus tab
Vomiting Domstal(Domperidone)
Domperi tab

** Consult medical practitioner for proper doses

References:
[1] International Travel Health, World Health Organization, January, 2010

[2] High Altitude Medicine Guide, http://www.high-altitude-medicine.com

[3] Altitude.org, http://www.altitude.org

[4] Paul Anderson, "Preparing for Safe Travel to High Altitude", http://mayoresearch.mayo.edu/asap/upload/preparing_for_safe_travel.pdf

[5]Climbing High, the climbing guide, http://www.climbing-high.com