- Altitude sickness: risk factors
- Acute mountain sickness
- High brain edema
- Altitude pulmonary edema
- Altitude sickness: prevention
- Altitude sickness: treatment
- Accompanying conditions and complications of altitude sickness
- Other dangers related to being in high mountains
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Altitude sickness is the result of the body's failure to adapt to the conditions in the mountains. It can be very dangerous, especially if you do not recognize it in time and do not provide help. If you do not have a basic understanding of this hazard, it can have very serious consequences, including a threat to your he alth and life. It is worth finding out how to protect yourself from altitude sickness and what are its symptoms.
Altitude sicknessis a group of symptoms caused by high altitude, where the atmosphere is thin, the atmospheric pressure is low, and therefore less oxygen in the air.
It is obvious that there will also be less of it in the alveoli, which results in hypoxemia, i.e. oxygen deficiency in the blood, which in turn causes hypoxia, i.e. a state in which the oxygen concentration in the tissues is too low in to their needs.
The disease (up to a certain level) is not caused by altitude itself, but by quickly overcoming a large difference in elevation.
It is hypoxia that is responsible for the development of symptoms, they result first from the body's attempts to adapt to new conditions, and then from damage to those organs that are most sensitive to the lack of oxygen, i.e. the brain.
Normal responses to adapt are first when the heart beats faster - this is intended to increase blood flow and to compensate for the low amount of oxygen by providing more frequent oxygen.
Then breathing accelerates and deepens, and after prolonged stay at high altitude, the production of erythropoietin by hypoxic kidneys increases, this hormone stimulates the bone marrow to produce red blood cells.
Unfortunately, we cannot predict in whom and with what severity the symptoms will appear.
When this happens and how quickly it will go depends, among other things, on altitude, he alth (e.g. pulmonary hypertension) and climbing speed.
It should be remembered that everyone who moves to a great height is exposed to altitude sickness, so it affects not only mountaineers, but also, for example, skiers.
Unfortunately, this disease happens despite being cautious, even in peopleexperienced, our actions may significantly reduce its intensity.
It is believed that below 2500m above sea level the disease does not occur, although some changes in human functioning can be noticed.
Between 2500 and 3500m above sea level the disease is rare, and when climbing quickly it is usually mild.
Altitude sickness is more dangerous at altitudes above 3500m above sea level, then it may lead to pulmonary and brain edema, especially when climbing fast, and above 5800m above sea level. there is so little oxygen in the air that it is impossible to acclimatize effectively and this disease is common.
Altitude sickness: risk factors
The main risk factor is the lack of prudence and a reliable assessment of one's skills and he alth. It is believed that the susceptibility to the disease is individual, but the risk of this disease is greater if:
- high altitude reached
- the need for acclimatization is ignored
- the acclimatization process is not carried out properly
- you gain altitude too quickly
- early symptoms of altitude sickness are ignored
- the need for proper hydration is ignored
- the person has had high- altitude pulmonary or brain edema or suffers from chronic diseases
- people over 50
The term " altitude sickness" includes three main diagnoses:
- acute mountain sickness
- altitude pulmonary edema
- high brain swelling
Acute mountain sickness
It occurs in people who quickly reach high altitude, defeating more than 1,800 m, when not acclimated, can fall on it even up to 40% of people at an altitude of more than 2,500 m above sea level, including those staying in ski resorts.
The course may be mild, moderate or severe, and it is different for everyone depending on their own predispositions and preparation.
Symptoms of acute mountain sicknessappear within 24 hours of altitude change, they are very diverse and include, among others:
- headaches (especially after exercise, pulsating)
- difficulty sleeping
Can be confused with other conditions such as exhaustion, dehydration, cooling.
Diagnostics is facilitated by the Lake Louise AMS scale, it covers the severity of symptoms: headache, dizziness, stomach discomfort, fatigue, trouble sleeping. The symptoms disappear as the body adapts, which lasts for a few days, up to a week.
High brain edema
It appears as the next stage of altitude sickness, when, despite the symptoms of acute mountain sickness, the climber continues the expedition.
The initially minor ailments are joined by:
- motor coordination disorders, i.e. problems with maintaining balance
- muscle flaccidity
- no smoothness of movements
- disturbance of consciousness
The latter may take the form of impaired contact, drowsiness, psychomotor slowness, disorientation of time and space, hallucinations, delusions and finally coma.
Abnormal brain function can also cause seizures or neurological symptoms.
Usually cerebral edema occurs together with pulmonary edema, which further worsens the patient's condition.
High-volume cerebral edema can be fatal by respiratory paralysis when impressed.
Altitude pulmonary edema
Symptoms of pulmonary edema appear when climbing higher altitudes than in the case of acute mountain sickness, i.e. around 2400 m above sea level. for people who are not acclimatized and, respectively, higher for those who are prepared.
In the course of pulmonary edema, exudative fluid accumulates in the alveoli, impeding gas exchange and causing respiratory failure.
Hypoxia (oxygen deficiency in the alveoli) increases the blood flow through the lungs, which increases the pressure in the pulmonary vessels and causes pulmonary hypertension, and then damage to the wall of small vessels and the penetration of fluid into the lumen of the alveoli.
Symptoms of pulmonary edema are:
- shortness of breath
- chest tightness
- wet cough
- skin bruising
- faster heart rate and breathing
Pulmonary edema in the course of altitude sickness is so dangerous that it can cause death even within a few hours of the first symptoms appearing, thanks to quick medical assistance, the condition can be completely cured without permanent consequences.
Altitude sickness: prevention
Altitude sickness at extreme altitudes - above 5800 m above sea level it is practically impossible to avoid, but in the case of lower heights it is possible to significantly reduce its nuisance, and sometimes even prevent the appearance of symptoms.
Before each ascent to high altitudes - above 2500 m above sea level, and especially at extremely high altitudes, preparation is necessary, because it can provide not only greater comfort, but often even experience in the mountains.
Adequate preventionin addition to the obvious physical preparation for the trip, it is based on acclimatization, which is ensured by gradual, time-based increase in altitude (up to 1000 m a day), adequate consumption of isotonic fluids (over 3 liters a day), avoiding alcohol and consuming meals with a high content of carbohydrates.
In addition, avoid moving directly from the lowlands above 2750 m above sea level, and before heading to the mountains, spend at least one night at an altitude of 2000-2500 m above sea level
It is also important to properly plan the accommodation - above 3000 m above sea level. camps should be established every 600 meters.
Sometimes, as part of the prophylaxis of altitude sickness, it is recommended to take acetazolamide before the start of the trip, and in the prevention of its consequences, acetylsalicylic acid.
In addition, you should not ignore the emerging ailments, and in the event of their occurrence, do not increase the height and allow acclimatization.
Altitude sickness: treatment
The simplest rules about altitude sickness say that you feel unwell at altitude is caused by altitude sickness, unless proven otherwise.
Never go higher with symptoms of altitude sickness, and if your condition worsens, go down immediately.
It should be remembered that for anyone who quickly (within one day) overcomes the altitude difference above 1800 m and stays there, it is necessary to take into account the occurrence of symptoms of acute mountain sickness.
In case of suspicion of acute mountain sickness, the most important action must be taken in the mountains - stop increasing altitude for at least 24 hours, limit physical exertion, take painkillers if necessary, if that does not help, you may have to stop the trip and descend to the where symptoms were absent.
Usually this is not necessary as the disease is self-limiting.
Immediate evacuation and treatment in the hospital is necessary in the case of pulmonary and brain edema, because they are a serious threat to life, while waiting for help, the patient must be brought as low as possible, oxygen, acetazolamide and nifedipine can be given (if available) and plant him.
In hospitals, apart from pharmacological treatment, oxygen treatment is also offered, including in a hyperbaric chamber.
Accompanying conditions and complications of altitude sickness
Apart from the previously mentioned consequences of not treating altitude sickness, it may also coexist with the following ailments:
- periodic breathing- these are itdisturbed breathing during sleep, leading to frequent awakenings at night, and thus to daytime drowsiness and fatigue, because sleep does not give you rest; in this case, there are alternating episodes of apnea (caused by decreased activity of the respiratory center) and hyperventilation
- peripheral edema- result from impaired urine production, because due to low blood pressure less blood flows through the kidneys, edema is localized in peripheral parts of the body, they are not life threatening
- retinal bleedingi - it is an organ very sensitive to hypoxia; in the case of hypoxia, the compensating mechanism increases the amount of blood reaching the retina, which causes the capillaries to burst; the bleeding is usually asymptomatic and if it is not present near the macula, it does not deteriorate vision
- thromboembolic changes- pulmonary embolism, deep vein thrombosis, mainly due to blood flow disorder
- weakened immunity and slows down wound healing
Other dangers related to being in high mountains
It should also be remembered that being in the mountains is associated with other hazards, such as low temperature and windy weather, which may result in:
- hypothermia- a drop in body temperature below 35 degrees C, it manifests itself with chills, drowsiness, visual disturbances, slow heart rate, loss of consciousness
- frostbites - most often they affect fingers, nose, ears and cheeks, in the case of severe damage to deep tissues, the changes are irreversible and may end with amputation, the skin of the frostbitten parts is gray or waxy, sometimes with blisters, itching and burning
- rash- superficial dermatitis, the skin is red, tense, painful
- trench foot- occurs as a result of low temperature and high air humidity; the skin is moist, numbness, pain, and may blister.
- upper respiratory tract inflammation
The basis for preventing all the effects of low temperature is wearing warm, dry clothes, avoiding skin contact with cold objects, applying protective creams, heating and drying the body, and being physically active.
In addition, you should consume warm, high-energy meals and drinks on a regular basis. In the case of wounds, appropriate hygiene - washing and changing the dressing.
Another danger that mountain climbers face is solar radiation, in the mountains there isit is exceptionally strong not only due to the lack of cloud cover, but also due to the effect of reflection of rays from snow and ice. Diseases caused by radiation are, for example :
- snow blindness- it is caused by the absorption of UV rays by the conjunctiva and the cornea. It manifests itself with pain in the eyeballs, conjunctivitis, sometimes even temporary loss of vision.
Protection against these dangers is, of course, creams with a UV filter, clothing tightly covering the skin, and sunglasses or sun goggles with a UV filter.
Extreme alpine conditions can also exacerbate he alth problems that have so far been asymptomatic, an example of diseases that may reveal themselves during extreme conditions of the expedition are:
- ischemic heart disease
Therefore, before leaving, you should absolutely take care of your he alth, cure all, even banal diseases and perform basic tests.
People with unstable ischemic heart disease, arrhythmias and heart failure should not decide on mountain expeditions, because they can be life threatening not only for themselves but also for their companions.
On the other hand, during the stable period of many heart diseases, it is possible to travel to medium altitudes, similarly, stable asthma is usually not a contraindication to staying at high altitudes.
The risk of well-controlled diabetes lies in the misdiagnosis of hypoglycemia, which can be mistaken for high- altitude cerebral edema.
Departure and possible recommendations for the trip should be consulted with a doctor specializing in sports medicine and a doctor who deals with chronic diseases of the person who reigns the trip (cardiologist, pulmonologist, diabetologist).
A trip to the high mountains is associated with a heavy burden on the body, therefore, in order not to be a serious threat to life, it must take place during optimal well-being and full he alth.