In my previous article, I spoke about altitude sickness in general and the initial form of it called Acute mountain sickness. In this article, I will try to explain in more detail about the advance forms of altitude sickness commonly known as High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE).
However, this article is in no way an advice or recommendation to all of those who are planning for high altitude expedition and want to avoid any forms of altitude sickness. This article is a mere explanation of the phenomena, based on my personal experiences and opinions of seasoned adventurers. It is strictly recommended to consult a physician before taking on any medical precautions to prevent altitude sickness.

HAPE

So now, as much as Acute Mountain Sickness (AMS) is a condition caused at an elevation anywhere at or beyond 8000 feet, the chances for advance forms of altitude sickness are also there at the same elevation. HAPE is a condition where a human body tends to build up fluids in lungs. It starts when oxygen is lesser in air and blood vessels around lungs starts constricting which increases blood pressure. This in turn leads water into the lungs. The process enters into a vicious circle where more water gets into the lungs causing more reduction of oxygen in the blood and more water getting in lungs and so on.

The prominent symptoms under HAPE could be extreme fatigue and exhaustion and breathlessness even at rest. Another symptom that needs to be observed miraculously is coughing. Most of the trekkers are normal at base camps but when they reach higher altitude camps they start coughing. Now this isn’t normal and shouldn’t be taken lightly. We have read many articles that under HAPE the lips turn blue and a pink fluid comes out with coughing. Well that’s a stage that might come after 4-5 hours of initial HAPE symptom. Better not let it reach that point. If you see any team member coughing at higher altitudes who was normal at lower altitudes, don’t treat it with cough syrups. Sudden coughing along with breathlessness means nothing but signs of initial HAPE.

PRVENTION AND TREATMENT

The single best treatment of HAPE is nothing but descent. Clearly with descent, you would want to provide oxygen in the first place to the victim as the whole situation is caused by lack of oxygen. It is an important consideration to descent down to at least 7000-8000 feet where there are trees. If the situation occurred at 14000 feet and the victim has descended down to 12000 feet, it is not going to help.

But in this case, descend alone may require 7-8 hours or beyond which, for the victim may not be possible given fatigue, cough and/or breathlessness. Similarly, the person cannot be left like that on higher altitude given the escalating nature of HAPE and its fatal repercussions. What normally is done under such circumstances are the aid of certain medications. The most widely known drug is called Diamox which is a brand name for Acetazolamide. Diamox helps the victims acclimatize faster. The way it administers is it takes out bicarbonates out of the body through urination and acidifies the blood. When the blood is acidified, the human body tends to hyperventilate and takes in more breath and hence oxygen. Some of the mountaineers also suggests that Diamox alone is not enough. The victim must also be treated with another drug alongside called Niphedipine. Niphedipine helps reduce blood pressure. With low blood pressure the fluid accumulation also goes down and the victim may start feeling better in the next 4-5 hours. With this rest time on high altitude and drug having administered, now is time to move down to lower altitude preferably tree zone or at least 7000 -8000 feet.

HACE

Although the exact mechanism of HACE is not fully understood, it is thought to be the extreme form of altitude sickness. It is a condition where swelling in the brain tissue occurs due to leakage of fluids.

The prominent symptoms of this extreme form of altitude sickness are severe headache mainly because it has something to do with the brain. Nausea and vomiting are also observed under this condition. These are symptoms that the victim goes through and feels. However as a team member, the victim is to be observed in terms of lack of coordination and illogical in behavior. One simple test as a result of headache, nausea or vomiting is to draw a straight line and ask the victim to walk over it. If he/she is going through acute HACE, he may not be able to do it. In such environment you can draw the line by putting small stones in a straight line, or you may draw the line with your ice axe or walking pole if on a snow line. For HACE, the team needs to be really proactive given its rapid progressive nature leading into fatal results.

PREVENTION AND TREATMENT

Again descent is the single most effective remedy. Since it is the lack of oxygen that caused the condition, it the oxygen that will cure the person. But whenever HACE occurs, it occurs at altitudes where there is little or no time to descent to 7000-8000 feet or ideally to tree line altitude.

Under such circumstances, the aid of medication is sought. Again Diamox is a drug of choice but along with Dexamethasone or Dex which is a commonly used drug in HACE. Dexamethasone is a steroid and it doesn’t actually cures the condition but buys time for the victim to descend. The most common administration of these drugs is 250mg of Diamox along with 4mg of Dex. So the word prevails that this administration will relief the victim within an hour. It will give the victim a window to get out of there. So consistent communication and feedback with the victim is key here. The team leader must prepare backpack and spare a porter for the victim for his/her descend. And as soon as it is ensured that the drug has started working, he/ she starts trekking down to lower altitude. Normally Dex works for a period of 4-6 hours. If the destination time is longer than the drug administration time, the victim must take the second course of drug after 4-6 hours in order to continue his/ her descend.

The most important aspect of this treatment is when the victim arrives at a safe altitude, he/ she must not stop taking the drug immediately. Because it is a steroid that boosted energy levels, cutting it off immediately may lead into over fatigue. The victim must wean out the drug dosage slowly. So the course might follow cek nomor keluaran togel malam ini. update terbaru di Playme8 situs judi terpercaya this routine and I repeat here, this is merely what I’ve learned and heard from seasoned trekkers and not a prescription or recommendation in anyway. After reaching the safe altitude the victim may reduce Dex to 2mg in the next 4-6 hours and bring it down to 1mg in next 4-6hours and then stop taking it.

At this point almost every victim of HACE recovers with mild after effects of lingering or nausea but that shall not sustain and fade away in the next 8-10 hours’ time.

THE GOLDEN RULE

While AMS or any extreme forms of AMS are there to climb on any adventurer, it is a good idea to take preventive measures pre-trek. The golden rule is to start hydrating yourself before you start your trek or reach basecamp. Take as much water as you can. Even during your trek, it is highly recommended to stay highly hydrated and ensure water intake to avoid any forms of AMS. After all, prevention is always better than treatment.