what is the treatment of AMS?

If anybody has AMS sick then they should have to go down, down and down. It is very important and safety way and it is very good madicin for AMS. There is not magic altitude which you should descend. Go down to the place where you were comfortable before. This is usually about 300 meters pr more. Stay where you are and do not ascend if you have moderate AMS. If one is badly struck, we could only need time for him/her to go down by the use of inject able or oral steroid (dexamethasone at the dose of 4 to 8 mg 6 hourly), oxygen, diamox, pressure bag (Gamow bag) and diuretics (drug which makes one pee)Nifedipine, a drug used commonly in hypertension could be used in a setting of HAPE at the dose of 10mg three to four times per day. Diamox should be avoided in people who are allergic to sulfa drugs. The most common side effect is tingling of the hands and feet and the eyes and the lips. Some might experience that the aerated drinks taste flat. People may wake up several times in the night because of the diuretic effect. Gastritis is the commonest side effect with dexamethasone and can be effectively tackled with the use of drugs like ranitidine. Remember, all these only buy time one still needs to go down, go down and go down.

What do we do?

AMS is preventable and treatable. Our body is a machine, it always gives signs when it is malfunctioning. All we need to do is to listen to our body and help, not hinder its process. Avoid the risk factors. By slow ascent, we can digest the altitude, the process is called acclimatization. Here, our body gets sufficient time to adjust to the high altitude. It is prudent to take a rest day every third day with the rate of ascent not more than 400 metes per day after the altitude of 3000 meters. Climb high and sleep low is another of the dictum of altitude medicine. Moderate exertion on rest day is also recommended. People acclimatizing well will have increased diuresis which helps prevent fluid accumulating in the body. The process of acclimatization can be accelerated by the use of a drug called acetazlamide ( diamox) taken at a dose of 250mg twice daily (5mg/kg for kids)

what are the risk factors for AMS?

Rapid ascent is the main risk factor. Dehydration, airway infections, overexertion, sleeping pills, obesity, and alcohol are other risk factors. Previous history of altitude sickness is the vest predictor of whether one would be struck again. Non flexible itineraries. peer pressure, tough and stoic personality are some other risk factors. Excess chill and cold exposure is a known risk factor for HAPE.

Why does AMS happen?

All is because of low atmospheric pressure. Low atmospheric pressure leads to low oxygen tension in the air which we inhale and causes a series of changes in the body which may lead to AMS. There is leakage of fluid from the blood stream into the brain. The arteries of the lungs also constrict causing increase in pressure in them which promotes fluid leakage into the lungs. These occur when our body does not get sufficient time to adapt to the change in pressure. Some people may be unable to adapt at all because of some abnormalities in their bodies, for e.g. absence of one pulmonary artery. the relative preparation their brain and the skull etc.

About HAPE.

It is characterized by increasing breathlessness even at rest, productive cough and bluish discoloration of lips and tongue. The sputum may become blood tinged later on. It usually strikes the second night onwards. The bluish discoloration is a late sign and should not happen in the hands of good friends. One important thing about HAPE is that it can occur in a setting outside of AMS. people can have full blown HAPE without headache and other symptoms of AMS. Thus when confronted with the above signs and symptoms of HAPE, toes should not be ignored or dismissed in the light of absence of headache. HAPE likewise seems to be a completely different pathology. It is invariably fatal unless interfered with.

About HACE

It is characterized by increasing headache and vomiting, staggering gait, altered consciousness and other neurological signs. It is thought to be the progression of AMS. The condition develops more rapidly in the night in someone with AMS, probably because of further decrease in ventilation during the night. This explains the common belief in our people that somebody with a bad headache should not go to sleep. This is true but what is equally important is that they should not remain in the same place either. This fact highlights the importance of keeping a high index of suspicion and making decisions about descent in the day and not waiting for the night or the next morning. The single most important test to detect HACE in somebody with AMS is the tandemgait test where a person walks straight on a line in a hill to toe fashion.If he falls beyond the line, it is strongly suggestive of HACE. The person becomes comatose soon thereafter. It is invariably fatal unless interfered with.

Acute Mountain sickness (AMS)

It is a syndrome complex of (a) headeach (b) nausea (c) dizziness (d) sleeplessness and (e) fatigue. Of these, headache is the cardinal symptom. Nobody is immune to AMS above 2500 meter. It is not related to physical fitness or gender. Early AMS feels exactly like alcohol hangover. It is also heralded by the feeling of deep inner chill or a sense of not being well. Late or advanced AMS denotes increase in severity of the above mentioned symptoms. A typical picture will be a porter arrives at a high altitude carrying a heavy load. Immediately, he goes in a corner of a dark room and rests there covered with a blanket from head to toe. He doesn't want any tea or snacks. He starts to throw up once in a while. \when asked, he says he has the worst headache as if somebody is hammering a nail into his forehead and he feels terrible. He is still huddled in the corner at dinner time. When friends bring him food, he does not even want to look at it. when asked, he says yes, I want to go down. High altitude sickness is classified as (a) mild AMS (b) moderate AMS and (c) severe AMS.
If not interfered with, AMS could progress to two fatal complications. (a) High altitude cerebral edema (HACE), meaning swelling of the brain or water in the brain. (b) high altitude pulmonary edema (HAPE) meaning water in the lungs.