Article on Altitude, Sun Injury, Effect of Cold : By Dr. Anjali Murmu
( Divisional Medical Officer ) Indian Railways.
ALTITUDE ILLNESS
As you ascend to higher altitudes, atmospheric pressure decreases, the air is thinner and less oxygen is available. It is also colder, drier and the ultraviolet rays from the sun are stronger. Each of these changes may have unpleasant effects on your body.
Above 8000 feet, altitude illness affects 20 to 30% of visitors from low altitude to some degree. The extent to which you are affected depends on how quickly you ascend, what elevation you attain, how hard you exercise, what you eat and drink and what health problems you may have (smoking, emphysema, asthma, anemia, diabetes and high blood pressure). When planning a trip to an area above 8000 ft. consult with your doctor if you have any questions
After arriving at high altitude, you will probably notice that your breathing is faster and/or deeper, and you may feel short of breath especially when exercising. This is the body's first and most effective response to higher elevation. In addition your heart is likely to beat faster and you may develop nausea, unusual tiredness, headache, or have difficulty sleeping.
Visitors with one or more of these symptoms may have acute mountain sickness (AMS). This form of altitude illness usually resolves in a day or two. If the symptoms become worse or if you are concerned be sure to consult a doctor.
A wet cough, increasing shortness of breath or the feeling of fluid collecting in your lungs may signal a more serious condition called High Altitude Pulmonary Edema or HAPE. HAPE requires immediate medical attention.
Before you leave home, you can do a few things to decrease the effects of high altitude. Spending two nights at modest altitude, 5000 to 6000 feet may decrease symptoms when you ascend. Eating foods which are high in carbohydrates, drinking more water than usual and using less salt may also help.
Diamox is a prescription drug which prevents unpleasant symptoms for many people who may be exceptionally prone to AMS. Our experience suggests a small dose can be effective: 125 mg twice a day beginning 24 hours before arrival to high altitude. Diamox should not be taken by people who are allergic to sulfa drugs. Discuss use and possible minor side effects (tingling sensations, altered taste, increased urination) with your doctor.
Once you arrive take it easy for the first day or two. Adequate hydration is important in the prevention of altitude illness. Drink two or three times more water or fluid than usual. Limit alcohol consumption for two or three days and minimize caffeine intake. Limit salty foods and increase carbohydrate consumption. Above all, listen to your body! Do not push the limits of your physical capabilities. If you feel worse, seek medical attention! Minor altitude illness symptoms can occasionally become life threatening.
SUN INJURY
At high altitude the ultraviolet rays from the sun are more intense and therefore more damaging. Even when it is cloudy the risk of sunburn is extreme. Before going out protect yourself and your family from the suns ultraviolet rays. Apply a sunscreen SPF 15-30 to your skin before beginning outdoor activities and every two hours while outside.
To prevent sun injury to the eyes, wear sunglasses or goggles with (UV) protection.
COLD INJURY
The air temperature falls about three degrees Fahrenheit for every 1000 feet of elevation gain. Therefore, temperatures in the high country can drop rapidly. Hypothermia (low body temperature) can occur when you are wet, chilled, fatigued or dressed inappropriately; even during warm weather. Warning signs are confusion, difficulty speaking, irritability and loss of coordination. Bring along extra clothes, drink and eat sufficiently and watch for warning signs in each other. If in doubt, stop, warm up, take fluids and food, and if necessary send for help.
Frostbite is caused by cold exposure resulting in ice crystals forming in the skin. It frequently occurs in the extremities, specifically the nose, ears, fingers and toes. The skin becomes numb, firm and yellowish white in color. Rewarming causes tingling and pain with skin color changes and blisters occurring in severe cases. Prevention includes dressing appropriately in winter (layering), wearing boots and gloves that are not wet or too tight, and taking time to warm up frequently.
Consult a doctor for severe cases of any of these injuries due to exposure to cold weather. If you have any concerns regarding cold injury related problems please contact
Your doctor ASAP.
Human body, either working or exposed to working at high altitude can be hazardous. The information provided here is designed for educational use only and is not a substitute for specific training or experience.
What is High Altitude?
Altitude is defined on the following scale High (8,000 - 12,000 feet [2,438 - 3,658 meters]), Very High (12,000 - 18,000 feet [3,658 - 5,487 meters]), and Extremely High (18,000+ feet [5,500+ meters]). Since few people have been to such altitudes, it is hard to know who may be affected. There are no specific factors such as age, sex, or physical condition that correlate with susceptibility to altitude sickness. Some people get it and some people don't, and some people are more susceptible than others. Most people can go up to 8,000 feet (2,438 meters) with minimal effect. If you haven't been to high altitude before, it's important to be cautious. 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 acclimatized.
What Causes Altitude Sickness
The concentration of oxygen at sea level is about 21% and the barometric pressure averages 760 mmHg. As altitude increases, the concentration remains the same but the number of oxygen molecules per breath is reduced. At 12,000 feet (3,658 meters) the barometric pressure is only 483 mmHg, so there are roughly 40% fewer oxygen molecules per breath. In order to properly oxygenate the body, your breathing rate (even while at rest) has to increase. This extra ventilation increases the oxygen content in the blood, but not to sea level concentrations. Since the amount of oxygen required for activity is the same, the body must adjust to having less oxygen. In addition, for reasons not entirely understood, high altitude and lower air pressure causes fluid to leak from the capillaries which can cause fluid build-up in both the lungs and the brain. Continuing to higher altitudes without proper acclimatization can lead to potentially serious, even life-threatening illnesses.
Acclimatization
The major cause of altitude illnesses is going too high too fast. Given time, your body can adapt to the decrease in oxygen molecules at a specific altitude. This process is known as acclimatization and generally takes 1-3 days at that altitude. For example, if you hike to 10,000 feet (3,048 meters), and spend several days at that altitude, your body acclimatizes to 10,000 feet (3,048 meters). If you climb to 12,000 feet (3,658 meters), your body has to acclimatize once again. A number of changes take place in the body to allow it to operate with decreased oxygen.
The depth of respiration increases. Pressure in pulmonary arteries is increased, "forcing" blood into portions of the lung which are normally not used during sea level breathing. The body produces more red blood cells to carry oxygen, The body produces more of a particular enzyme that facilitates the release of oxygen from hemoglobin to the body tissues.
Prevention of Altitude Sickness
Prevention of altitude illnesses falls into two categories, proper acclimatization and preventive medications. Below are a few basic guidelines for proper acclimatization.
If possible, don't fly or drive to high altitude. Start below 10,000 feet (3,048 meters) and walk up.
If you do fly or drive, do not over-exert yourself or move higher for the first 24 hours.
If you go above 10,000 feet (3,048 meters), only increase your altitude by 1,000 feet (305 meters) per day and for every 3,000 feet (915 meters) of elevation gained, take a rest day. "Climb High and sleep low." This is the maxim used by climbers. You can climb more than 1,000 feet (305 meters) in a day as long as you come back down and sleep at a lower altitude.
If you begin to show symptoms of moderate altitude illness, don't go higher until symptoms decrease (& Don't go up until symptoms go down").
If symptoms increase, go down, down, down!
Keep in mind that different people will acclimatize at different rates. Make sure all of your party is properly acclimatized before going higher.
Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts per day). Urine output should be copious and clear.
Take it easy; don't over-exert yourself when you first get up to altitude. Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.
Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.
The acclimatization process is inhibited by dehydration, over-exertion, and alcohol and other depressant drugs.
Preventive Medications
Diamox (Acetazolamide) allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg. twice a day (morning and night). (The standard dose was 250 mg., but their research showed no difference for most people with the lower dose, although some individuals may need 250 mg.) Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. These side effects may be reduced with the 125 mg. dose. Side effects subside when the drug is stopped. Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies. Frank Hubbell of SOLO recommends a trial course of the drug before going to a remote location where a severe allergic reaction could prove difficult to treat.
Dexamethasone (a steroid) is a prescription drug that decreases brain and other swelling reversing the effects of AMS. Dosage is typically 4 mg twice a day for a few days starting with the ascent. This prevents most symptoms of altitude illness. It should be used with caution and only on the advice of a physician because of possible serious side effects. It may be combined with Diamox. No other medications have been proven valuable for preventing AMS.
Acute Mountain Sickness (AMS)
AMS is common at high altitudes. At elevations over 10,000 feet (3,048 meters), 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 acclimatization process. Symptoms usually start 12-24 hours after arrival at altitude and begin to decrease in severity about the third day. The symptoms of Mild AMS are headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and a 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 2-4 days as the body acclimatizes. 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. AMS is considered to be a neurological problem caused by changes in the central nervous system. It is basically a mild form of High Altitude Cerebral Edema (see below).
Basic Treatment of AMS
The only cure is either acclimatization or descent. Symptoms of Mild AMS can be treated with pain medications for headache and Diamox. Both help to reduce the severity of the symptoms, but remember, reducing the symptoms is not curing the problem. Diamox allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg. twice a day (morning and night). (The standard dose was 250 mg., but their research showed no difference for most people with the lower dose, although some individuals may need 250 mg.) Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. These side effects may be reduced with the 125 mg. dose. Side effects subside when the drug is stopped. Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies. Frank Hubbell of SOLO in New Hampshire recommends a trial course of the drug before going to a remote location where a severe allergic reaction could prove difficult to treat.
Moderate AMS
Moderate AMS includes severe headache that is not relieved by medication, nausea and vomiting, increasing weakness and fatigue, shortness of breath, and decreased coordination (ataxia). Normal activity is difficult, although the person may still be able to walk on their own. At this stage, only advanced medications or descent can reverse the problem. Descending even a few hundred feet (70-100 meters) may help and definite improvement will be seen in descents of 1,000-2,000 feet (305-610 meters). Twenty-four hours at the lower altitude will result in significant improvements. The person should remain at lower altitude until symptoms have subsided (up to 3 days). At this point, the person has become acclimatized to that altitude and can begin ascending again. The best test for moderate AMS is to have the person "walk a straight line" heel to toe. Just like a sobriety test, a person with ataxia will be unable to walk a straight line. This is a clear indication that immediate descent is required. It is important to get the person to descend before the ataxia reaches the point where they cannot walk on their own (which would necessitate a litter evacuation).
Severe AMS
Severe AMS presents as an increase in the severity of the aforementioned symptoms, including shortness of breath at rest, inability to walk, decreasing mental status, and fluid buildup in the lungs. Severe AMS requires immediate descent to lower altitudes (2,000 - 4,000 feet [610-1,220 meters]).
There are two other severe forms of altitude illness, High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). Both of these happen less frequently, especially to those who are properly acclimatized. When they do occur, it is usually with people going too high too fast or going very high and staying there. The lack of oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain.
High Altitude Pulmonary Edema (HAPE)
HAPE results from fluid buildup in the lungs. The fluid in the lungs prevents effective oxygen exchange. As the condition becomes more severe, the level of oxygen in the bloodstream decreases, and this can lead to cyanosis, impaired cerebral function, and death. Symptoms include shortness of breath even at rest.
