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Monday, April 11, 2011

ACUTE MOUNTAIN SICKNESS

This is experienced by people who go up too high too quickly; some suffer at 2500m, other reach 5500m without trouble. The cause of the syndrome is unknown.

Clinical features
The earliest symptoms are headache, nausea and vomiting, followed by lassitude, muscle weakness, breathlessness, dizziness, rapid pulse and insomnia, retinal haemorrhages may occur.
Acute mountain sickness may herald onset of two severe, possibly fatal, complications: pulmonary oedema and, less commonly, cerebral oedema. Youth speed of ascent, re ascent, exertion and absolute altitude are associated with pulmonary oedema. cerebral oedema causes drowsiness, irritability, confusion, fits and coma. Its presence may be confirmed by detection of papilloedema.
Venous thromboses, which may lead to pulmonary embolism,may afflict the partially acclimatised; they are due to increased viscosity of blood and are prevented by adequate hydration and exercise.
Management
The complications are prevented by time spent acclimatising, ascending gradually, adequate hydration and by acetazolamide which probably acts by causing metabolic acidosis and an increased drive to ventilation. They are treated by descending 500-1000m rapidly and by giving oxygen. Frusemide 40-120 mg daily and morphine 15mg as required is the treatment for pulmonary oedema, and dexamethasone for cerebral oedema.

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