Altitude sickness

Altitude sickness (mountain sickness) is an illness that ranges from a mild headache and weariness to a life-threatening build-up of fluid in the lungs or brain at high altitudes.
As more & more people are traveling to areas of high elevation for skiing and mountain climbing, acute altitude sickness has become one of the major health problems. There are two types of sickness.

High Altitute Sickness

HAPE (High altitude pulmonary edema)

It occurs when fluid builds up within the lungs, it makes breathing extremely difficult. Usually it occurs after the second night spent at a high altitude.
HAPE often comes on quickly. If HAPE is left untreated, it can progress to respiratory collapse and ultimately to death.
It is the number one cause of death from altitude sickness.

It is a condition in which fluid builds up within the brain. As the brain swells with fluid, the person's mental state changes.
Loss of coordination, coma, and, finally, death can follow unless treated promptly.

Body does not adjust to the rate of ascent into higher altitude.
It develops at elevations higher than 8,000 feet (about 2,400 meters) above sea level and when the rate of ascent exceeds 1,000 feet (300 meters) per day.
Ascending too rapidly
Overexertion within 24 hours of ascent
Inadequate fluid intake
Hypothermia
Consumption of alcohol or other sedatives
Symptoms
Fatigue
Headache
Dizziness
Insomnia
Shortness of breath during exertion
Nausea
Decreased appetite
Swelling of extremities
Social withdrawal
Generally people attribute their symptoms to other causes such as an uncomfortable bed, bad food, or a hangover
High altitude pulmonary edema (HAPE)
It is an advanced form of acute altitude sickness, causes the following progression of symptoms:
Shortness of breath at rest
Gurgling respirations
Wet cough with frothy sputum
Possible fever
Respiratory failure

It begins with confusion.
A person developing HACE begins having trouble keeping up with the group.
Walking and coordination become impaired.
Brain continues to swell, lethargy and then coma will develop.
If left untreated, HACE will ultimately result in death.
If symptoms such as headache or shortness of breath do not improve promptly with simple changes, visiting a doctor may be helpful if descent is inconvenient and a doctor is available.
Descend immediately if shortness of breath at rest, mental confusion or lethargy, or loss of muscle coordination develops. Symptoms of most people with acute altitude sickness improve by the time they reach a medical facility, which is generally located at a lower altitude.

Crackles or rales (a rattling sound) when listening to the patient's lungs.
Shortness of breath at rest may indicate HAPE.
The patient’s vital signs may be abnormal have low-grade fever and faster-than-normal heart and breathing rates.
Pulse oxymeter, which measures oxygen saturation of the blood, may reveal that the patient's oxygen saturation is lower than expected for that particular altitude.
The doctor may treat the patient with fever and cough for pneumonia in addition to HAPE.
HACE is diagnosed if a person's mental state is altered or coordination is lost at high altitude

Delay further ascent until symptoms improve.
Rest and stay warm.
Take acetaminophen for headache.
Do not use sleeping pills or other central nervous system depressants to treat insomnia because they can suppress breathing.
If symptoms continue, do not travel any higher.
If symptoms worsen, descend approximately 1,000-2,000 feet (300-600 meters) immediately. Descending to lower altitudes or delaying further ascent are treatments for acute altitude sickness until symptoms are gone.
A Gamow’s bag may be used if descent is not feasible.
Oxygen (2-4 liters per minute) will improve oxygen saturation of blood.
Aspirin or acetaminophen (Tylenol) may be taken for headache.
For nausea, the doctor may prescribe prochlorperazine (STEMETIL), an antinauseatic medication that also enhances the body's ability to increase the breathing rate in response to low-oxygen environments.
Sleeping pills for insomnia should not be taken. They are potentially dangerous because they can slow breathing.
Acetazolamide (Diamox) 125 mg twice a day may be prescribed to hasten acclimatization.
Acetazolamide is a drug that increases urine output that increases kidney excretion of bicarbonate. This decreases the blood pH, thereby stimulating extra breathing, which results in higher oxygen levels in the blood.

In addition, Acetazolamide corrects night time pauses in breathing known as periodic breathing. Acetazolamide also improves symptoms of insomnia.

It responds best to descent.
If Oxygen is available, should be provided.
Nifedipine (DEPIN) a medication for high blood pressure, is beneficial for HAPE.
Antibiotics may be given if a fever is present and pneumonia is possible..
The only definitive treatment for HACE is descent.
Dexamethasone (Decadron, a steroid) may be beneficial.
Generally, if Dexamethasone is considered, then a plan for descent should be in place unless descent is impossible.
Some people, after receiving Dexamethasone, may feel so much better that they want to continue ascending. Under no circumstance should this be allowed.
Oxygen may be helpful.
A Gamow bag may be used until descent is possible.
Anyone with HACE or HAPE should be kept as comfortable as possible.
Exertion should be minimized, even during descent. Therefore it is necessary to arrange descent for the ill person by whatever means available like helicopter, snowmobile, or mule,
Follow instructions regarding activity limitation, use of additional oxygen, postponement of climbing, or immediate descent, if required.
Take medications as prescribed.
Do not drink alcohol, and avoid smoking tobacco.
Seek medical attention immediately if symptoms worsen or if new symptoms develop.
For people who do not know the rate at which their bodies adjust to high altitude, the following preventive measures are recommended.

If traveling by air to a ski area above 8,250 feet (2,500 meters), incorporate a layover of 1-2 days at an intermediate altitude.
Avoid physical exertion for the first 24 hours.
Drink plenty of fluids, and avoid alcoholic beverages.
Consume a high-carbohydrate diet.
If mountain climbing or hiking, ascend gradually once past 8,000 feet (2,400 meters) above sea level
Increase the sleeping altitude by no more than 1,000 feet (300 meters) per 24 hours. The mountaineer's rule is "climb high, sleep low. This means that on layover days, a climber can ascend to a higher elevation during the day and return to a lower sleeping elevation at night. This helps to hasten acclimatization.