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A. M. S.
(ACUTE MOUNTAIN SICKNESS)
Tibet is sometimes
known as the ‘roof of the world’. The high plains over which
you will travel on your overland trip from Kathmandú to
Lhasa average 11000 to 13000 ft, while some of the mountain
passes are over 18000 ft (5.220 Mt.). At such high
altitudes, there is a chance of having symptoms of mountain
sickness. Because this trip is by bus rather than foot
(there fore without much physical exertion), these mountain
sickness symptoms usually do not become severe. Nonetheless,
one should know about the symptoms and treatment of altitude
sickness.
Altitude
sickness:
At sea level, a whole atmosphere of pressure pushes in on
the air one breathes. As one goes higher and higher, there
is less atmosphere and hence less atmospheric pressure
pushing in on the air breathed in to the lungs. Human bodies
experience that lack of air pressure as a lack of oxygen.
Until the body has a chance to adapt, one may experience
symptoms of mountain sickness. Different people’s bodies
adapt or acclimatize at different rates. These
acclimatization rate are not at all related to what kind of
physical shape one is in. for example, an Olympic marathon
runner and or an obese, remote control TV watching couch
potato are equally likely to have symptoms of altitude
sickness at the same altitude.
Symptoms of A. M.
S. – The symptoms of altitude sickness are rather vague,
variable, and easy to attribute to other causes. However,
when at high altitude, assume any of the following symptoms
are mountain sickness until proven otherwise.
Symptoms of
ams
|
Mild
|
moderate |
severe |
|
Headache |
severe headache |
altered |
|
Nausea |
vomiting |
consciousness |
|
Malaise |
dizziness |
poor judgment |
|
Low appetite |
irritability |
shortness of breath |
|
Sleeplessness |
dry cough |
wet cough |
|
. |
Little urination |
coughing blood |
|
. |
. |
Unable to walk |
If
you have symptoms:
-
Rest – do not over
exert yourself
-
Do not go higher.
-
Drink lots of
fluids. Avoid alcohol.
-
let someone know
how you are feeling
-
Try aspirin or
paracitamol for headache discomfort
-
Avoid any
sedatives – especially sleeping pill or narcotics. These
medicines eill slow your breathing and worsen your symptoms.
-
Consider use of
acetazolamide (Diamox) to prevent or treat symptoms.
-
If symptoms are
severe or worsening, return to lower altitude.
With the help of a
physician, consider the use of other medicines such as
Dexamethasome every 6 hours, Nifedipine 10 mg every 8 hours
and or oxygen.
Acetazolamide
(Diamox)
If AMS
symptoms are moderate or severe, or mild symptoms are getting
worse, acetazolamide treatment may be beneficial. The dose
is 250 mg every 12 hours. This medicine stimulates breathing
and therefore helps the body get more oxygen. Acetazolamide
especially helps one breath better at night and hence, helps
sleep without causing any sedating effects. Possible side
effects of acetazolamide include tingling (pins and needles
feeling) of hands, Toes or lips. Increased urination, and
change in taste of carborated beverages. These
symptoms are merely annoyances, resolve when the drug is
stopped, and do not indicate allergic reactions, travelers
who have allergies to sulfa antibiotics and have never tried
acetazolamide should not take this medicine, acetazolamide
is as sulfa derivative, there is a slight possibility of
allergic cross reaction.
Prevention –
Besides acting to treat symptoms of mountain sickness,
acetazolamide can also help prevent or decrease severity of
AMS symptoms before they occur. The overland journey from
Kathmandú to Lhasa covers much altitude in a short period of
time. I.e. traveling from Zhangmu to Xegar Dzong in one day
gains 2,050 mt of altitude. The best way to avoid AMS
is to ascend slowly. This is not possible in a week long trip
from Kathmandú to Lhasa. Therefore it is quite reasonable to
take 125 – 250 mg of acetazolamide 2 times per day 24 hours
before ascending to high altitude to prevent mountain
sickness. Diamox may be continued until one acclimatizes or
stops going higher.
Especially for
people who have been to high altitude before and have had
AMS, taking acetazolamide 24 hours before going high is very
helpful in preventing altitude sickness. Drinking lots
of water while taking acetazolamide is very important,
since, acetazolamide makes one urinate more.
Most
people do just fine at high altitude with nothing more than
a few annoying symptoms of headache or shortness of breath
with exertion. Being able to identify know what to do about
mountain sickness can help prevent serious problems
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