Hypothermia, Altitude Sickness,Sunburn,Prickly Heat,Heat Exhaustion, Heat Stroke, Fungal InfectionsArticle on High Altitude Health Tips : By Dr. Sanjiv Sharma ( Divisional Medical Officer ) Indian Railways.
---------------------------------------------------------------------------------------------------------------------------
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 Illnesses:
-------------------------------
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 Illnesses:
---------------------------------
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)
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
ill 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.
