The Downside of Getting High by Dr Lyndon Laminack
With more people taking to the hills and other adventures, the seriousness of altitude or mountain sickness is coming into focus.
As its name implies, mountain sickness is a form of illness that is triggered off by altitude. Generally, it will be felt at altitudes greater than 3,600m though early symptoms can come on as early as 2,300m.
Cause and Effect
Because people vary greatly in their susceptibility to the condition, it is difficult to predict any given person’s level of risk at any altitude. For reasons not well understood, people under the age of 20, especially makes, are most susceptible to some of the more severe complications of altitude sickness.
Also, its effects are amplified by the speed of ascent to the higher levels. Therefore, people who ascend to altitudes by walking are less likely to develop problems than those who fly or drive there.
A number of changes occur in the body on reaching high altitude, primarily due to the lower level of oxygen as atmospheric pressure reduces. These changes put more demand on the heart and lungs, and as a result, the blood becomes more alkaline. Although the body can compensate for these changes, the process usually takes a few days.
Mountain sickness can manifest itself as early as six to eight hours after ascent. More commonly, it appears within two to four days. It can be considered in two categories: benign and malignant.
Benign Mountain Sickness
Symptoms include poor appetite, headache, nausea and vomiting, insomnia and a feeling of fullness in the chest. These symptoms will usually be resolved in two to three days of remaining at the same altitude. Although the condition is benign, it should always be considered a warning sign of malignant mountain sickness.
Malignant Mountain Sickness
This can develop from the benign form sometimes quite rapidly. There are two complications which can occur together or separately. The first is high altitude pulmonary edema. This is a situation in which the lung becomes filled with fluid, causing severe shortness of breath, low grade fever, cough – either dry or frothy – and cyanosis or blue lips.
The other is high altitude cerebral edema. Essentially, this is a swelling of the brain. In additional to headaches, which may be severe, the afflicted becomes confused and lethargic. Behaviour can become bizarre and the person’s gait becomes unsteady, resembling the walk of a drunk. The condition may progress to coma and death if left untreated.
What to Do
The primary treatment of either form of malignant mountain sickness is to get the victim to a lower altitude as quickly as possible. Even if the symptoms seem benign but have persisted for more than 72 hours, descent is imperative. People who have cerebral edema will, by definition, have impaired judgment and should not be relied upon to decide for themselves how sick they are. If oxygen is available, it should be given, but it is not nearly as important as descent. Never keep a severely affected person at the same altitude waiting for help to arrive. Use whatever means available to get to a lower altitude.
While some medication is potentially useful in the treatment and prevention of mountain sickness, their utility is minor compared with prompt evacuation to a lower altitude. Furthermore, drugs may have unintended side effects and their use is not recommended except on expeditions which have trained medical personnel. In particular, narcotic painkillers and sleeping pills should be avoided to treat headache and insomnia because they may depress respiration and accentuate the problem.
Preventive Measures
Gradual ascent is the key to prevention. Avoid rapid climbs above 2,400m. Take a acclimatizing “rest day” every 900m above 2,700. It is all right to climb higher on the ‘rest day’ provided you return to a lower altitude to sleep. Remember that some people are more susceptible than others, so don’t dismiss the possibility of mountain sickness because only one member of the party is affected.
In addition to the above precautions, people with certain medical conditions such as chronic heart or lung problems and sickle cell anemia, should not climb or work at high altitude. Sometimes epilepsy, migraine and some blood clotting disorders will be worsened. If there are any doubts to your particular condition, you should consult your doctor.
Dr Lyndon Laminack is a Senior Medical Co-ordinator with International SOS, a company with operations in 24 countries which helps people who get into trouble anywhere in the world.
With more people taking to the hills and other adventures, the seriousness of altitude or mountain sickness is coming into focus.
As its name implies, mountain sickness is a form of illness that is triggered off by altitude. Generally, it will be felt at altitudes greater than 3,600m though early symptoms can come on as early as 2,300m.
Cause and Effect
Because people vary greatly in their susceptibility to the condition, it is difficult to predict any given person’s level of risk at any altitude. For reasons not well understood, people under the age of 20, especially makes, are most susceptible to some of the more severe complications of altitude sickness.
Also, its effects are amplified by the speed of ascent to the higher levels. Therefore, people who ascend to altitudes by walking are less likely to develop problems than those who fly or drive there.
A number of changes occur in the body on reaching high altitude, primarily due to the lower level of oxygen as atmospheric pressure reduces. These changes put more demand on the heart and lungs, and as a result, the blood becomes more alkaline. Although the body can compensate for these changes, the process usually takes a few days.
Mountain sickness can manifest itself as early as six to eight hours after ascent. More commonly, it appears within two to four days. It can be considered in two categories: benign and malignant.
Benign Mountain Sickness
Symptoms include poor appetite, headache, nausea and vomiting, insomnia and a feeling of fullness in the chest. These symptoms will usually be resolved in two to three days of remaining at the same altitude. Although the condition is benign, it should always be considered a warning sign of malignant mountain sickness.
Malignant Mountain Sickness
This can develop from the benign form sometimes quite rapidly. There are two complications which can occur together or separately. The first is high altitude pulmonary edema. This is a situation in which the lung becomes filled with fluid, causing severe shortness of breath, low grade fever, cough – either dry or frothy – and cyanosis or blue lips.
The other is high altitude cerebral edema. Essentially, this is a swelling of the brain. In additional to headaches, which may be severe, the afflicted becomes confused and lethargic. Behaviour can become bizarre and the person’s gait becomes unsteady, resembling the walk of a drunk. The condition may progress to coma and death if left untreated.
What to DoWhile some medication is potentially useful in the treatment and prevention of mountain sickness, their utility is minor compared with prompt evacuation to a lower altitude. Furthermore, drugs may have unintended side effects and their use is not recommended except on expeditions which have trained medical personnel. In particular, narcotic painkillers and sleeping pills should be avoided to treat headache and insomnia because they may depress respiration and accentuate the problem.
Preventive Measures
Gradual ascent is the key to prevention. Avoid rapid climbs above 2,400m. Take a acclimatizing “rest day” every 900m above 2,700. It is all right to climb higher on the ‘rest day’ provided you return to a lower altitude to sleep. Remember that some people are more susceptible than others, so don’t dismiss the possibility of mountain sickness because only one member of the party is affected.
In addition to the above precautions, people with certain medical conditions such as chronic heart or lung problems and sickle cell anemia, should not climb or work at high altitude. Sometimes epilepsy, migraine and some blood clotting disorders will be worsened. If there are any doubts to your particular condition, you should consult your doctor.
Dr Lyndon Laminack is a Senior Medical Co-ordinator with International SOS, a company with operations in 24 countries which helps people who get into trouble anywhere in the world.
