Preventing AMS, HACE and HAPE
Acute Mountain Sickness (AMS)
AMS is common; depending on the altitude gained and the speed of ascent, incidence ranges from 20 to 80%. Typically symptoms appear anytime during the first 36 hours after an ascent. If you rest at the same altitude, symptoms usually disappear quickly (but this can take up to 4 days) and you are now acclimatized to this altitude. AMS may reappear as you ascend higher still, and acclimatization has to occur again.
Symptoms are due to fluid accumulation in brain tissue and vary from mild to severe; it can progress to HACE if it is ignored. People often blame cold-heat-infection-alcohol-insomnia
exercise-unfitness-migraine for their AMS symptoms and carry on up. To continue ascending with symptoms of AMS is dangerous and has led to many deaths.
NB. It may be quite difficult to tell if a young child is developing AMS. The only symptoms may be increased fussiness, crying, loss of interest or loss of appetite.
Symptoms & signs
Treatment
Periodic (Cheyne Stokes) breathing
This unpleasant condition occurs while sleeping at altitude. If someone suffers from it, always check them for symptoms of altitude illness.
Symptoms & signs
Treatment
Give Diamox, 'the high altitude sleeping pill', 125-250 mg at night or 12-hourly.
Notes on acetazolamide (DiamoxTM)
This is a mild diuretic, which acidifies the blood thus improving respiration and acclimatization. There are three reasons for using DiamoxTM: prevention of AMS, treatment of AMS, and for sleeping difficulties.
Prevention of AMS
There is good evidence that Diamox TM is effective for preventing AMS. However, routine preventative use for all trekkers on all treks is NOT recommended.
Preventative use is recommended for those who have a past history of Altitude Illness, or when rapid height gain is unavoidable.
Poor sleep
This is a common problem at altitude. First line of treatment for insomnia is check warmth of sleeping bag, decent insulation and advise no caffeine. DiamoxTM, which acts as a respiratory stimulant, is indicated for sleep disturbance at altitude, particularly where this is associated Nith periodic breathing (repeated bouts of stopping breathing followed by gasping breaths).
Some altitude physicians refer to DiamoxTM as 'the high altitude sleeping pill'. The starting dose is DiamoxTM 125mg (half a tablet) an hour before going to bed. (If symptoms persist try 125 mg twice daily. If that doesn't work, try 125 mg in the morning and 250 mg at night).
Diamox; allergy and side-effects
DiamoxTM may cause an allergy in some people. It must be avoided if there is past history of an adverse reaction to DiamoxTM or sulfa containing drugs (eg. SeptrinTM, BactrinTM). Some common side effects of DiamoxTM:
A common concern about DiamoxTM is that it will mask the onset of altitude illness. There is no evidence that DiamoxTM masks the onset of AMS, HACE or HAPE. However, DiamoxTM is not guaranteed to work so even if someone is taking DiamoxTM, and AMS, HACE or HAPE may still develop.
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