Altitude sickness, or “acute mountain sickness”, is a condition caused as a result of the effect of
atmospheric changes on the human body when ascending to a very high altitude. The condition is
potentially fatal, but fatalities are easily avoidable. Lack of awareness of this condition, resulting in
delayed or inadequate treatment, claims the lives of victims every year. The condition is more likely to
occur when individuals travel to heights of 8000 feet or higher. The condition can affect anyone and
one’s health and fitness levels have little bearing on one’s vulnerability to altitude sickness. If the
symptoms are ignored, the condition can be fatal.Altitude sickness is generally classified into three
categories based on the symptoms and severity:Mild Altitude Sickness is discomforting but not life
threatening. It causes symptoms similar to those of a hangover, with victims experiencing headaches,
nausea and fatigue. Although mild altitude sickness may not be life threatening, it should be treated
very seriously as this is can be a warning sign of the impending risk for more severe disease
manifestations.”HAPE” or High Altitude Pulmonary Edema causes breathlessness as fluid begins to
accumulate in the lungs. Breathlessness at rest is a worrying symptom, especially at high altitudes-for
example, if you just scaled Kilimanjaro or Everest. HAPE can be rapidly fatal if not recognized and
treated in a timely fashion.”HACE” or High Altitude Cerebral Edema may have set in if you notice
symptoms like confusion, disorientation and stumbling. HACE is the accumulation of fluid around the
brain. This condition often sets in along with HAPE but is just as dangerous even when it occurs in
isolation. Death usually follows within just a few hours.What are the Causes of Altitude
Sickness?Altitude sickness is caused by the decreased oxygen concentration at higher altitudes and the
subsequent decrease in the oxygen carrying capacity in the body. All vital organs, especially the brain,
require adequate oxygen levels to function properly. If the body is exposed to a decreased oxygen
environment too suddenly, illness can ensue. Altitude sickness is unpredictable in that it can affect
almost anyone irrespective of age, gender or physical health. For unclear reasons, some people are
more susceptible to altitude sickness than others. Usually, people can ascend to heights of up to 8,000
feet with almost no ill effect. The higher and faster you ascend the greater the risk of altitude sickness.
The risk is minimal to those who have already been at that altitude before, but it is a lot higher for those
who have never been to such a high altitude environment before. Acclimatization is therefore of the
utmost importance.If the human body is given enough time to adjust to the atmospheric changes
associated with higher altitudes, it will adapt to the reduced oxygen levels. This means that once you get
to a height of 8,000 feet your body will adjust to the high altitude if you give it a couple of days. After
climbing to 9 or 10,000 feet you will need to allow your body to acclimatize once again.Based on our
understanding of altitude sickness and why it occurs there are certain risk factors that one should
consider: – Rapid ascent poses the highest risk.- The higher the altitude the greater the risk.- Risk may
also rise as the altitude at which you sleep rises. – Some individuals may also be predisposed to altitude
sickness because of heredity.- Physical activity and higher levels of exertion at a high altitude greatly
increase the risk.- Past experience of altitude sickness could imply future vulnerability as well.The
symptoms of altitude sickness will show considerable variation depending on the severity or type of
altitude sickness and also based on your speed of ascent and levels of exertion at that high an altitude.
The symptoms could be mild to life-threatening, affecting the functioning of vital organs like the lungs,
brain and heart. In most cases, patients suffer from mild to moderate altitude sickness with symptoms
that could include:- Dizziness and light headedness- Headaches, nausea and vomiting- Appetite loss-
Fatigue or exhaustionSymptoms of Altitude Sickness – Increased heart rate- Difficulty sleepingIn cases of
severe altitude sickness the signs will be more disturbing and are life threatening. Symptoms include: –
Breathlessness without exertion and tightness of the chest- Cough that may also include blood- Cyanosis
or bluish tinge in the skin- Grayness or paleness in complexion- Confusion and reduced social
interaction- Decreased consciousness and possible violent outburstsEarly diagnosis is important to
successfully treat the condition, but in most cases, sophisticated diagnostic tools will not be available.
Decisions need to be made based purely on the symptoms that are present. When medical care is
available, health professionals will be able to make a rapid diagnosis based on symptoms and physical
examination. Listening to the lungs through a stethoscope may reveal “crackles”, which are basically
sounds that emanate from the lungs when there is a buildup of fluid within. If you are admitted to a
hospital to undergo treatment for altitude sickness you may need to undergo the following tests:- Blood
Tests,- Chest X-rays,- CT Scans, and- Electrocardiogram or ECG.What are the Treatments for Altitude
Sickness?The first response is always critical when dealing with such situations and basic first aid is vital
as medical care is often too far away because of the remoteness of the location. Mountaineers are
always advised to use the ‘buddy system’ (always travel with at least one other person) because of the
tendency amongst most people to refuse to acknowledge their own symptoms. Fatalities often result
when individuals insist on continuing an ascent as they are unwilling or unable to recognize the
symptoms. If anyone in the group shows signs of altitude sickness, the following steps should be taken
to control the condition immediately:- Stop the ascent and camp until the symptoms have subsided
completely. Acclimatization usually occurs within a few days.- The affected individual should not be
allowed to smoke or consume alcohol.Avoid Smoking & Alcohol ConsumptionIf necessary, provide the
affected individual with treatment immediately:- Administer aspirin or paracetamol in the appropriate
dosage.- Periodic deep breathing should be encouraged to ensure a reduction in CO2 levels in the
blood.- Dexamethasone should also be administered in the appropriate dosage to help treat brain
swelling.- Diuretic drugs should also be administered to minimize fluid buildup around the lungs and
brain.- Oxygen should also be administered from a portable cylinder.- Acetazolamide may be
administered to hasten acclimatization.- Ensure that the person has adequate water to avoid
dehydration.Erythropoiten, a red blood cell production stimulating hormone, can be given
prophylactically to decrease the risk of developing altitude sickness. It is often inneffective in the acute
setting because it takes several days for acclimatization to take place.Keep in mind that administering
altitude sickness medications and providing oxygen therapy to the patient does not mean that the
ascent can continue as soon as the symptoms disappear. This can turn out to be fatal and it is important
that you wait for a few days for acclimatization to take place. When the symptoms indicate that the
person may have a severe case of altitude sickness you should initiate a descent immediately, aiming for
a descent of at least 1500 to 3,000 feet.Signs of HACE or HAPE should be treated as an emergency
requiring hospitalization. Administering oxygen helps to combat breathing problems but medical care is
essential to treat the problems of fluid accumulation in the lungs or brain swelling.-medindia