This  what you need to be aware of  before planning  a trip to mountains .
8 mins read

This what you need to be aware of before planning a trip to mountains .

 

Contributed by 

Dr. Vipul Agarwal.

M.B;B.S  MD(Internal Medicine)

Consultant physician

Department of Internal Medicine

Yenepoya medical college, Mangaluru

You can find me at-

E-mail: vipul.msrmc@gmail.com

linkedIn/ Instagram/ facebook

In our lifetime, we dream of traveling to mountains at least once. It is all fun and great enjoyment for all of us .Few precautions must be addressed before to keep acute mountain sickness at bay.

What is acute mountain sickness (AMS)? Ascending to or being at a new high altitude may cause acute mountain sickness. It is caused by lower oxygen levels in the air and thus the blood. Travel to high altitude may also exacerbate certain pre-existing medical conditions.

What are its symptoms ? Symptoms usually occur within 6 to 12 hours of arrival at altitudes above 8000 feet (2400 m). Symptoms can begin as soon as one hour or as long as 24 hours after arriving. AMS does not occur after adjusting to a given altitude for three or more days. The symptoms of AMS are similar to a hangover, and include:

●Headache

● tiredness

●Lightheadedness or dizziness

●Lack of appetite

●Difficulty staying asleep (waking frequently)

●Nausea, sometimes with vomiting

What to do next? If you develop signs of AMS, you should NOT go higher until your symptoms have resolved (usually within 24 hours). You should rest and avoid drinking alcohol and taking sedatives or sleeping pills as you recover.This may mean that you, as well as your fellow travelers, will be delayed or unable to go as high or as far as you had hoped. However, moving higher while you have symptoms of AMS can lead to serious complications.

It is often possible to prevent mountain sickness by ascending slowly and allowing your body to adjust as you go.

Serious complications of high altitude disease can usually be avoided by watching for early signs and symptoms of high altitude illness and responding quickly.

what are my chances of having mountain sickness?

It is not possible to know in advance if you will become ill when traveling to a high altitude. In addition, being physically fit does not decrease your chances of developing a high altitude illness.

However, certain groups are at increased risk, including people who:

●Have a prior history of high altitude illness

●Overexert themselves or drink alcohol before adjusting to the change in altitude

●Ascend rapidly from low elevation to sleeping altitudes above 8000 feet (2400 m).

●Ascend rapidly (>500 to 1000 m /day in sleeping altitude), when over 9000 feet (2700 m).

●Have a medical problem that affects breathing like asthma, tuberculosis, chronic obstructive pulmonary disease

PREPARING TO TRAVEL

If you will be sleeping above 8000 feet (2400 m) and have concerns about developing altitude sickness because of prior episodes or other risk factors, you should make an appointment with a physician.

During this visit, you should discuss your travel plans, availability of medical care at your destination, and the potential need for medicines to prevent and/or treat high altitude illness.

Methods for reducing risk :

Traveling with medical conditions.

People with certain medical conditions need to take special precautions when traveling at high altitudes:

●Asthma does not worsen at high altitudes, although cold-induced bronchospasm is a consideration in low temperature environments at high altitude.

●If you use oxygen because of lung disease, you will need a higher oxygen flow rate at high altitude. If you do not need oxygen for your lung disease at home, you might need oxygen at high altitude. Check with your doctor before you travel.

●If you have lung disease, such as COPD, cystic fibrosis, pneumonia, pulmonary hypertension or sleep apnea, you should check with your doctor prior to travel to high altitude.

●If you have high blood pressure, be aware that traveling to high altitude could raise or sometimes lower your blood pressure; sometimes BP medication needs to be adjusted. Discuss with your doctor.

●If you are pregnant, traveling to sleeping altitudes of 8000 to 9000 feet is not risky for a normal pregnancy. If you have any complications of pregnancy, or if you are a smoker, discuss going to altitude with your doctor.

AMS prevention:

Ascend slowly — Ascending slowly is the best way to avoid AMS.

●If you live below 5000 feet (1500 m), avoid ascending rapidly. On the first night, avoid sleeping above 9000 feet (2800 m).

●If you plan to travel above 9800 feet (3000 m), do not increase your sleeping altitude more than 1600 feet (500 m) per day as you go higher. Plan a day of rest for every 3300 feet (1000 m) you ascend. On this rest day, do not over-exert yourself.

●Climb high and sleep low. Hike to a higher altitude during the day and return to a lower elevation to sleep at night. This will help you adjust to the altitude.

●If you plan to ski, hike, or climb, do not over-exert yourself during the first few days at altitude. Pacing yourself is very important. Avoid alcohol and sleeping pills, especially as you are adjusting to the altitude in the first two days.

●If you drink caffeine (coffee, tea, soda) regularly, do not stop drinking it before or during your trip. Caffeine is safe at high altitudes, and stopping it suddenly can cause symptoms similar to AMS.

 • Consider taking a preventive medicine — 

Prevention usually includes a medicine called acetazolamide (brand name: Diamox), which you start taking the day before you ascend and continue for 48 hours or until you reach the highest point of your trip. Acetazolamide speeds up the process of acclimatization. discuss with your doctor before taking the medications.

Acetazolamide can temporarily cause carbonated drinks to taste unpleasant. Other side effects can include the need to urinate more frequently, numbness or tingling in the hands or feet, nausea, drowsiness, or blurry vision. Acetazolamide is not recommended for pregnant women.

Acetazolamide is a sulfa medicine. If you are allergic to sulfa, talk to your doctor to determine if you should take a test dose before traveling.

Treatment of AMS

 AMS treatment includes rest, descent, and may also include medicines to relieve symptoms. You should not exercise or proceed higher until your symptoms have resolved.

●Headache – You can take non-prescription medicines for headache, such as paracetamol (brand name: dolo, calpol), or ibuprofen (brand name- brufen)

●Nausea or vomiting – If you have nausea or vomiting, a prescription medicine such as ondansetron (brand name: emset) may be helpful.

●Descent – If your symptoms do not improve or worsen over 24 to 48 hours, descend to an altitude where you feel better. Most people feel better after descending 1600 to 3300 feet (500 to 1000 m).

●Oxygen – If needed, treatment with supplemental oxygen via tank or concentrator can reduce the symptoms of AMS. You can use oxygen for a period of time (eg, one hour), only when you have symptoms, or while sleeping, which is especially helpful. Small handheld canisters of oxygen that provide only a few breaths of oxygen are unlikely to provide sustained relief. Home oxygen companies are may be present in some high-altitude resort areas.

●Acetazolamide – Acetazolamide is a prescription medicine that you can take to treat and prevent AMS.

●Dexamethasone – Dexamethasone is a steroid that can reduce symptoms of AMS. You can take dexamethasone with acetazolamide, if needed. Dexamethasone increases blood sugar levels in people with diabetes.

When to seek help — AMS symptoms should improve as you adjust to the altitude, usually within 24 to 48 hours. If your symptoms worsen at any point, you should descend and seek help.

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