Treatment for altitude sickness includes: Symptoms, Diagnosis, Treatment & Prevention

11.03.197328.08.2021 by alexxlab

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Symptoms, Diagnosis, Treatment & Prevention

Overview

What is altitude sickness?

If you’ve ever hiked up a mountain and felt yourself getting nauseous or lightheaded, you may have experienced altitude sickness, also called mountain sickness. This condition happens when you travel to a high altitude (elevation) too quickly.

It doesn’t happen only to hikers. Just visiting a high-altitude location can cause problems for some. Symptoms happen when your body tries to adjust to the lower air pressure and lower oxygen levels at high altitudes.

Who is at risk for altitude sickness?

Anyone can get altitude sickness. Your age, sex and general health don’t seem to affect your risk. You may be at higher risk if you:

Have a lung or heart condition: Your healthcare provider may recommend avoiding high altitudes if possible.
Are pregnant: Talk to you provider before traveling to a high-altitude location.
Live at low elevation: Since your body isn’t used to higher altitudes, you have a greater risk for symptoms. If you’re planning a trip to a high-altitude location, be aware of the symptoms of altitude sickness and how to treat it.
Previously had altitude sickness: Talk to your provider about prevention and treatment before your next trip.

What is considered a “high elevation” in terms of getting altitude sickness?

Climbing to these elevations can bring on symptoms of altitude sickness:

High altitude: 8,000 to 12,000 feet above sea level.
Very high altitude: 12,000 to 18,000 feet.
Extremely high altitude: 18,000+ feet.

For context, New York City is at an elevation of 33 feet above sea level. Denver (known as the “Mile High City”) sits at 5,000 feet, and many Rocky Mountain ski slopes are at 11,000 feet or higher. The Grand Canyon is 6,600 feet above sea level. The summit of Mount Everest is over 29,000 feet.

How common is altitude sickness?

Altitude sickness may occur in up to half of people who climb to elevations above 8,000 feet.

What are the different forms of altitude sickness?

Most people who get altitude sickness get AMS, acute mountain sickness. Higher than 10,000 feet, 75% of people will get mild symptoms . There are three categories of AMS:

Mild AMS: Symptoms, such as mild headache and fatigue, don’t interfere with your normal activity. Symptoms improve after a few days as your body acclimates. You can likely stay at your current elevation as your body adjusts.
Moderate AMS: Symptoms start to interfere with your activities. You may experience severe headache, nausea and difficulty with coordination. You’ll need to descend to start to feel better.
Severe AMS: You may feel short of breath, even at rest. It can be difficult to walk. You need to descend immediately to a lower altitude and seek medical care.

Two severe forms of altitude illness occur less frequently but are more serious. Both can be life-threatening. You need to descend immediately and receive medical treatment for:

HAPE (High-altitude pulmonary edema): HAPE produces excess fluid on the lungs, causing breathlessness, even when resting. You feel very fatigued and weak and may feel like you’re suffocating.
HACE (High-altitude cerebral edema): HACE involves excess fluid on the brain, causing brain swelling. You may experience confusion, lack of coordination and possibly violent behavior.

Symptoms and Causes

What causes altitude sickness?

Altitude sickness results from a rapid change in air pressure and air oxygen levels at higher elevations. You may have symptoms if you travel to a high elevation without giving your body time to adjust to less oxygen. Even if you’re physically fit, you can still experience altitude sickness.

In addition, high altitude and lower air pressure can lead to fluid leaking from blood vessels. Researchers don’t understand exactly why this happens. This leakage causes fluid to build up in your lungs and brain. Ignoring moderate or severe symptoms can lead to a life-threatening situation.

What are the symptoms of altitude sickness?

You’ll likely feel nauseous and lightheaded. You may vomit and have a headache. Different levels of altitude sickness have different symptoms:

Symptoms of mild, short-term altitude sickness usually begin 12 to 24 hours after arriving at high altitude. They lessen in a day or two as your body adjusts. These symptoms include:

Dizziness.
Fatigue and loss of energy.
Shortness of breath.
Loss of appetite.
Sleep problems.

Symptoms of moderate altitude sickness are more intense and worsen instead of improve over time:

Worsening fatigue, weakness and shortness of breath.
Coordination problems and difficulty walking.
Severe headache, nausea and vomiting.
Chest tightness or congestion.
Difficulty doing regular activities, though you may still be able to walk independently.

Severe altitude sickness is an emergency. The symptoms are similar to moderate AMS, but more severe and intense. If you start experiencing these symptoms, you must be taken to a lower altitude immediately for medical care:

Shortness of breath, even when resting.
Inability to walk.
Confusion.
Fluid buildup in the lungs or brain.

HAPE, when fluid builds up in the lungs, prevents oxygen from moving around your body. You need medical treatment for HAPE. Symptoms include:

Cyanosis, when your skin, nails or whites of your eyes start to turn blue.
Confusion and irrational behavior.
Shortness of breath even when resting.
Tightness in the chest.
Extreme fatigue and weakness.
Feeling like you’re suffocating at night.
Persistent cough, bringing up white, watery fluid.

HACE happens when the brain tissue starts to swell from the leaking fluid. You need medical treatment for HACE. Symptoms include:

Headache
Loss of coordination.
Weakness.
Disorientation, memory loss, hallucinations.
Psychotic behavior.
Coma.

Diagnosis and Tests

How is altitude sickness diagnosed?

If you get a headache and at least one other symptom with 24 to 48 hours of moving to a higher elevation, it’s most likely altitude sickness. If you’re climbing, a more experienced climber may recognize symptoms of altitude sickness and guide you to get help.

If you have severe altitude sickness, a healthcare provider will ask about your symptoms, activities and location. The provider may perform a physical exam, including listening to your chest.

Will I need tests to diagnose altitude sickness?

You may need a chest X-ray to see if there is any fluid in your chest. In severe cases, your healthcare provider may order a brain MRI or CT scan to check for fluid in the brain.

Management and Treatment

How is altitude sickness treated?

The main treatment for altitude sickness is to move to a lower elevation as quickly and safely as possible. At the very least, do not go higher. If symptoms are mild, staying at your current elevation for a few days might be enough to improve the symptoms.

Other treatments depend on how severe the symptoms are:

Mild altitude sickness: Over-the-counter medicines can relieve headaches. Other symptoms will improve once your body adjusts or you move to a lower altitude.
Moderate altitude sickness: Symptoms should improve within 24 hours once you are 1,000 to 2,000 feet lower than you were. Within three days, you should feel completely better.
Severe altitude sickness, HACE and HAPE: If you have severe symptoms, you must be taken immediately to an elevation that’s no higher than 4,000 feet. Get to a healthcare provider as soon as possible. You may need hospitalization.

What treatments are available for severe altitude sickness?

Treatments depend on your symptoms:

For fluid in the brain (HACE), you may need dexamethasone, a steroid that helps reduce swelling in the brain. Dexamethasone is sometimes prescribed as a preventive medication.
For fluid in the lungs (HAPE), you may need oxygen, medication, a lung inhaler or, in severe cases, a respirator.
If you need more oxygen, a provider might prescribe acetazolamide, which increases your breathing rate, so you take in more oxygen. The medicine helps your body adjust faster to the higher elevation and reduces symptoms of altitude sickness.

Prevention

How can altitude sickness be prevented?

The best way to prevent altitude sickness is to go slow — called acclimatization. This process allows your body time to adjust to the change in oxygen levels. Take your time when traveling up. For instance, spend a day at a point midway up before continuing to ascend.

You can also talk to your healthcare provider about taking acetazolamide before your trip. Taking it 24 hours before traveling to a high altitude and continuing for five days can help prevent altitude sickness. Dexamethasone can also be used preventively, but it can have serious side effects. Talk to your provider before your trip.

Outlook / Prognosis

What’s the outlook for someone with altitude sickness?

Most people who get altitude sickness get the mild form. Once you return to a lower elevation (or stay at your current elevation without climbing higher), symptoms improve.

Are there long-term effects of altitude sickness?

If you take care and move to a lower elevation when you feel symptoms, altitude sickness has no long-term negative effects. You’ll recover within a few days. Once you feel better, you can continue to travel to higher elevations, as long as you do so slowly and carefully.

Can altitude sickness be fatal?

In rare cases, altitude sickness can be life-threatening. If you develop HAPE or HACE, you are at risk for complications such as coma or even death. Get treatment as soon as possible to reduce your risk.

Can altitude sickness be cured?

Altitude sickness is temporary. Once you return to a lower altitude, you’ll feel better. When you begin your ascent again (or on your next climb), make sure to travel slowly to let your body acclimate.

Living With

If I’m planning a hike to a very high elevation, how can I hike safely without getting altitude sickness?

These steps can help your body acclimate:

Walk up: Start below 10,000 feet and walk to a high altitude instead of driving or flying. If you drive or fly to an elevation higher than 10,000 feet, stay at your first stop for at least 24 hours before going higher.
Go slow: Once above 10,000 feet, don’t increase your altitude more than 1,000 feet a day.
Rest: Build a rest day into your schedule for every 3,000 feet you climb.
“Climb high and sleep low”: If you climb more than 1,000 feet in a day, come down to sleep at a lower altitude.
Know your body: Recognize the signs and symptoms of altitude sickness. Move to a lower altitude (or avoid climbing higher) if you notice any symptoms.
Stay hydrated: Drink 3-4 quarts of water per day.
Avoid alcohol: Alcohol can dehydrate your body. It also has stronger effects at higher elevations, which can impair judgment.
Eat carbs: Eat a diet that’s more than 70% carbohydrates.
Know the “don’ts”: Avoid tobacco and depressant drugs, such as sleeping pills and tranquilizers.

What should I ask my doctor?

If you’re planning to travel to high altitudes, ask your healthcare provider:

Should I take a preventive medication to avoid altitude sickness?
Do I have any risk factors that would prevent me from visiting high elevations?
What other steps can I take to prevent altitude sickness?
What steps should I take if I start to feel symptoms during my climb?

A note from Cleveland Clinic

Altitude sickness symptoms can range from uncomfortable to life-threatening. But with some planning and precautions, you can avoid this condition. The best way to prevent it is to move at a slower pace and let your body adjust. If you notice symptoms at high elevation, don’t push yourself to go farther. Get back down to a lower elevation and let your body adjust before moving up, slowly and carefully.

Symptoms, Diagnosis, Treatment & Prevention

Overview

What is altitude sickness?

Who is at risk for altitude sickness?

Anyone can get altitude sickness. Your age, sex and general health don’t seem to affect your risk. You may be at higher risk if you:

Have a lung or heart condition: Your healthcare provider may recommend avoiding high altitudes if possible.
Are pregnant: Talk to you provider before traveling to a high-altitude location.
Live at low elevation: Since your body isn’t used to higher altitudes, you have a greater risk for symptoms. If you’re planning a trip to a high-altitude location, be aware of the symptoms of altitude sickness and how to treat it.
Previously had altitude sickness: Talk to your provider about prevention and treatment before your next trip.

What is considered a “high elevation” in terms of getting altitude sickness?

Climbing to these elevations can bring on symptoms of altitude sickness:

High altitude: 8,000 to 12,000 feet above sea level.
Very high altitude: 12,000 to 18,000 feet.
Extremely high altitude: 18,000+ feet.

How common is altitude sickness?

Altitude sickness may occur in up to half of people who climb to elevations above 8,000 feet.

What are the different forms of altitude sickness?

Most people who get altitude sickness get AMS, acute mountain sickness. Higher than 10,000 feet, 75% of people will get mild symptoms . There are three categories of AMS:

Mild AMS: Symptoms, such as mild headache and fatigue, don’t interfere with your normal activity. Symptoms improve after a few days as your body acclimates. You can likely stay at your current elevation as your body adjusts.
Moderate AMS: Symptoms start to interfere with your activities. You may experience severe headache, nausea and difficulty with coordination. You’ll need to descend to start to feel better.
Severe AMS: You may feel short of breath, even at rest. It can be difficult to walk. You need to descend immediately to a lower altitude and seek medical care.

Two severe forms of altitude illness occur less frequently but are more serious. Both can be life-threatening. You need to descend immediately and receive medical treatment for:

HAPE (High-altitude pulmonary edema): HAPE produces excess fluid on the lungs, causing breathlessness, even when resting. You feel very fatigued and weak and may feel like you’re suffocating.
HACE (High-altitude cerebral edema): HACE involves excess fluid on the brain, causing brain swelling. You may experience confusion, lack of coordination and possibly violent behavior.

Symptoms and Causes

What causes altitude sickness?

What are the symptoms of altitude sickness?

You’ll likely feel nauseous and lightheaded. You may vomit and have a headache. Different levels of altitude sickness have different symptoms:

Symptoms of mild, short-term altitude sickness usually begin 12 to 24 hours after arriving at high altitude. They lessen in a day or two as your body adjusts. These symptoms include:

Dizziness.
Fatigue and loss of energy.
Shortness of breath.
Loss of appetite.
Sleep problems.

Symptoms of moderate altitude sickness are more intense and worsen instead of improve over time:

Worsening fatigue, weakness and shortness of breath.
Coordination problems and difficulty walking.
Severe headache, nausea and vomiting.
Chest tightness or congestion.
Difficulty doing regular activities, though you may still be able to walk independently.

Shortness of breath, even when resting.
Inability to walk.
Confusion.
Fluid buildup in the lungs or brain.

HAPE, when fluid builds up in the lungs, prevents oxygen from moving around your body. You need medical treatment for HAPE. Symptoms include:

Cyanosis, when your skin, nails or whites of your eyes start to turn blue.
Confusion and irrational behavior.
Shortness of breath even when resting.
Tightness in the chest.
Extreme fatigue and weakness.
Feeling like you’re suffocating at night.
Persistent cough, bringing up white, watery fluid.

HACE happens when the brain tissue starts to swell from the leaking fluid. You need medical treatment for HACE. Symptoms include:

Headache
Loss of coordination.
Weakness.
Disorientation, memory loss, hallucinations.
Psychotic behavior.
Coma.

Diagnosis and Tests

How is altitude sickness diagnosed?

If you have severe altitude sickness, a healthcare provider will ask about your symptoms, activities and location. The provider may perform a physical exam, including listening to your chest.

Will I need tests to diagnose altitude sickness?

You may need a chest X-ray to see if there is any fluid in your chest. In severe cases, your healthcare provider may order a brain MRI or CT scan to check for fluid in the brain.

Management and Treatment

How is altitude sickness treated?

Other treatments depend on how severe the symptoms are:

Mild altitude sickness: Over-the-counter medicines can relieve headaches. Other symptoms will improve once your body adjusts or you move to a lower altitude.
Moderate altitude sickness: Symptoms should improve within 24 hours once you are 1,000 to 2,000 feet lower than you were. Within three days, you should feel completely better.
Severe altitude sickness, HACE and HAPE: If you have severe symptoms, you must be taken immediately to an elevation that’s no higher than 4,000 feet. Get to a healthcare provider as soon as possible. You may need hospitalization.

What treatments are available for severe altitude sickness?

Treatments depend on your symptoms:

For fluid in the brain (HACE), you may need dexamethasone, a steroid that helps reduce swelling in the brain. Dexamethasone is sometimes prescribed as a preventive medication.
For fluid in the lungs (HAPE), you may need oxygen, medication, a lung inhaler or, in severe cases, a respirator.
If you need more oxygen, a provider might prescribe acetazolamide, which increases your breathing rate, so you take in more oxygen. The medicine helps your body adjust faster to the higher elevation and reduces symptoms of altitude sickness.

Prevention

How can altitude sickness be prevented?

Outlook / Prognosis

What’s the outlook for someone with altitude sickness?

Most people who get altitude sickness get the mild form. Once you return to a lower elevation (or stay at your current elevation without climbing higher), symptoms improve.

Are there long-term effects of altitude sickness?

Can altitude sickness be fatal?

Can altitude sickness be cured?

Living With

If I’m planning a hike to a very high elevation, how can I hike safely without getting altitude sickness?

These steps can help your body acclimate:

Walk up: Start below 10,000 feet and walk to a high altitude instead of driving or flying. If you drive or fly to an elevation higher than 10,000 feet, stay at your first stop for at least 24 hours before going higher.
Go slow: Once above 10,000 feet, don’t increase your altitude more than 1,000 feet a day.
Rest: Build a rest day into your schedule for every 3,000 feet you climb.
“Climb high and sleep low”: If you climb more than 1,000 feet in a day, come down to sleep at a lower altitude.
Know your body: Recognize the signs and symptoms of altitude sickness. Move to a lower altitude (or avoid climbing higher) if you notice any symptoms.
Stay hydrated: Drink 3-4 quarts of water per day.
Avoid alcohol: Alcohol can dehydrate your body. It also has stronger effects at higher elevations, which can impair judgment.
Eat carbs: Eat a diet that’s more than 70% carbohydrates.
Know the “don’ts”: Avoid tobacco and depressant drugs, such as sleeping pills and tranquilizers.

What should I ask my doctor?

If you’re planning to travel to high altitudes, ask your healthcare provider:

Should I take a preventive medication to avoid altitude sickness?
Do I have any risk factors that would prevent me from visiting high elevations?
What other steps can I take to prevent altitude sickness?
What steps should I take if I start to feel symptoms during my climb?

A note from Cleveland Clinic

Altitude Sickness | Cigna

Condition Basics

What is altitude sickness?

Altitude sickness occurs when you cannot get enough oxygen from the air at high altitudes. This causes symptoms such as a headache, loss of appetite, and trouble sleeping. It happens most often when people who are not used to high altitudes go quickly from lower altitudes to 8000 ft (2500 m) or higher. For example, you may get a headache when you drive over a high mountain pass, hike to a high altitude, or arrive at a mountain resort.

Mild altitude sickness is common. Experts do not know who will get it and who will not. Neither your fitness level nor being male or female plays a role in whether you get altitude sickness.

Altitude sickness can be dangerous. It is smart to take special care if you go high-altitude hiking or camping (like in the Rockies) or have plans for a vacation or trek in high-altitude countries like Peru, Ecuador, or Nepal.

Altitude sickness is also called acute mountain sickness.

What causes it?

Air is “thinner” at high altitudes. When you go too high too fast, your body cannot get as much oxygen as it needs. So you need to breathe faster. This causes the headache and other symptoms of altitude sickness. As your body gets used to the altitude, the symptoms go away.

What are the symptoms?

The symptoms of altitude sickness include:

A headache, which is usually throbbing. It gets worse during the night and when you wake up.
Not feeling like eating.
Feeling sick to your stomach. You may vomit.
Feeling weak and tired. In severe cases, you do not have the energy to eat, dress yourself, or do anything.
Waking up during the night and not sleeping well.
Feeling dizzy.

Your symptoms may be mild to severe. They may not start until a day after you have been at a high altitude. Many people say altitude sickness feels like having a hangover.

Altitude sickness can affect your lungs and brain. When this happens, symptoms include being confused, not being able to walk straight (ataxia), feeling faint, not being able to catch your breath even at rest, and having blue or gray lips or fingernails. These symptoms mean the condition is severe. It may be deadly.

If you are going on a high-altitude trek, learn about altitude sickness, its symptoms, and how to treat it. Look out for other people in your group.

How is it diagnosed?

If you are at a high altitude, your doctor may think you have this condition. Your doctor will ask you questions about your symptoms and examine you. To rule out other conditions, your doctor may ask if you have been drinking fluids or alcohol or using any medicines, or if you have a cold or the flu.

If you are hiking or camping, you and those with you need to know the symptoms of altitude sickness. People often mistake altitude sickness for the flu, a hangover, or dehydration. As a rule, consider your symptoms to be altitude sickness unless you can prove they are not.

How is altitude sickness treated?

The best treatment for altitude sickness is to go to a lower altitude. But if you have mild symptoms, you may be able to stay at that altitude and let your body get used to it. Symptoms often occur if you have just arrived at a mountain resort from a lower altitude.

If you stay at a high altitude, rest. You can explore the area, but take it easy. Limit any walking or activity. Drink plenty of water, but do not drink alcohol. Do not go to a higher altitude until your symptoms go away. This may take from 12 hours to 3 or 4 days.

For the headache, you can take an over-the-counter medicine, such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Do not give aspirin to anyone younger than 20. Aspirin has been linked to Reye syndrome, a serious illness. You may also use medicine to reduce feeling sick to your stomach or other symptoms.

A doctor can give you acetazolamide (Diamox). This speeds up how fast your body gets used to the higher altitude. Nifedipine (Procardia) and dexamethasone are also used for altitude sickness. You may also be able to use oxygen or a specially designed pressure chamber to treat altitude sickness.

Go to a lower altitude if your symptoms are moderate to severe, they get worse, or medicine or oxygen treatment does not help. Go down at least 1500 ft (450 m). Go to a lower altitude as fast as you can or get emergency help if someone with you has severe symptoms such as being confused or not being able to walk straight. Go with the person. Never let someone with severe altitude sickness go down alone.

How can you prevent it?

You may be able to prevent altitude sickness by taking your time when you go to high altitudes and using medicine in advance.

If you go to altitudes higher than 8,000 feet (ft), try to spend at least a night at a medium altitude before going higher. For example, in the United States, spend a night in Denver before going to the Rocky Mountains.
Do not fly into high-altitude cities. If this is not possible, avoid large meals, alcohol, and being very active after you arrive. Rest, and drink plenty of liquids. If you have symptoms, do not go higher until they have gone away.
Sleep at an altitude that is lower than the altitude you were at during the day. For example, if you ski at 9,500 ft during the day, sleep the night before and the night after at 8,000 ft.
You may consider taking medicines such as ibuprofen, acetazolamide (Diamox) or dexamethasone before traveling to high altitudes. These medicines may prevent or lessen symptoms. Talk to your doctor about this.

The Pharmacist’s Role in the Treatment and Prevention of Acute Mountain Sickness

ABSTRACT: Acute mountain sickness (AMS) is a common disorder, affecting patients who travel to areas of high altitude. Decreased barometric pressure and environmental temperatures associated with higher elevations can cause hypoventilation and hypoxemia. Major risk factors for AMS include rate of ascent, sleeping at a higher elevation, and individual susceptibility. Patients present with headache and additional symptoms such as nausea, vomiting, weakness, and/or anorexia. Nonpharmacologic treatment includes descent, rest, and oxygen therapy. Pharmacologic therapy with acetazolamide and/or dexamethasone is used for treatment and prophylaxis. Other prevention strategies include gradual ascent, sleeping at lower altitudes, and avoidance of alcohol and other depressants.

US Pharm. 2017;42(7)HS-22-HS26.

Each year, large numbers of people travel to places of high altitude for recreational pursuits (e. g., skiing, trekking, mountain climbing) as well as for work and military service. Furthermore, ski-resort towns in the western United States alone attract more than 30 million visitors annually.^1,2 As more people travel to higher elevations, the incidence of high-altitude illness (HAI) is also rising. HAI is a term used to describe three distinct syndromes including acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). AMS is the most common, with the reported incidence varying from 25% to 85% worldwide depending on elevation and rate of ascent. Both HACE and HAPE are considered life- threatening, but the incidence is extremely low (0.1% and 4%, respectively). Although AMS is often self-limiting, it can be debilitating, and if untreated, can progress to HACE or HAPE.^3,4 Awareness of AMS among pharmacists has become increasingly important. While pharmacists at higher elevations may see patients suffering from AMS and need to be familiar with appropriate treatment, pharmacists at lower altitudes must also be knowledgeable regarding AMS because patients may seek their advice prior to traveling.

Pathophysiology

The pathophysiology of AMS is unclear. However, current evidence suggests that decreased barometric pressure at higher altitudes results in hypoventilation, impaired gas exchange, and hypoxemia. This triggers a neurohormonal and hemodynamic response resulting in fluid retention, which can lead to cerebral edema, increased intracranial pressure, and the development of symptoms seen in AMS.^1,3 Additionally, environmental temperatures drop an average of 6.5°C per 1,000-foot gain in elevation, which increases the amount of oxygen required to maintain body temperature.² The decreased oxygen supply and increased demand at higher altitudes require the body to make adjustments in order to minimize hypoxemia and maintain cellular function. This process is called acclimatization and varies markedly among individuals.⁵

Epidemiology

Major risk factors associated with the development of AMS include rate of ascent, final elevation reached, sleeping elevation, and individual susceptibility. AMS affects both genders and all ages, although the incidence may be slightly lower in males and anyone aged 50 years or more. Other risk factors include vigorous exercise prior to acclimatization, a history of AMS, and permanent residence at elevations lower than 900 m.^1,3,6,7 Substances or conditions that alter ventilation may also increase the risk of AMS. This includes respiratory depressants like alcohol, sedative/hypnotic medications, and comorbid conditions such as moderate-to-severe chronic obstructive pulmonary disease and pulmonary hypertension.^5,8,9

Clinical Presentation and Diagnosis

The diagnosis of AMS is based on symptoms, setting, history, and the exclusion of other conditions.⁸ In 1991, a committee of experts at the International Hypoxia Symposium in Lake Louise, Canada, proposed a quantitative scoring system that evaluates the severity of presenting symptoms (see Lake Louise Self-Assessment Scoring System online at www. uspharmacist.com). Based on this system, AMS may be diagnosed when headache is present together with at least one other symptom (e.g., nausea, weakness, difficulty sleeping) in the setting of a recent gain in altitude.^9,10 The nonspecific symptoms seen in AMS are often misdiagnosed as a viral illness, dehydration, alcohol hangover, or exhaustion. A key differentiating factor, however, is the recent change in altitude, as symptoms usually occur within 6 to 12 hours of ascent, although they can appear as early as 1 hour following ascent.^1,3,5,9

Nonpharmacologic Treatment

Pharmacists should be able to recognize the manifestations of AMS in order to determine when nonpharmacologic treatment should be recommended and when referral is necessary (see Table 1). Nonpharmacologic options include stopping, resting, and/or descent.^6,11-14 If AMS is mild, stopping, resting, and increasing fluid intake may be sufficient treatment. ^3,8,12,14-16 Avoiding further ascent, alcohol, and sedatives will expedite symptom resolution, whereas additional ascent or exertion may cause symptom progression.^1,12,14,15 If resting does not yield improvement, descent of 500 to 1,000 m is recommended.^1,4,6,11 When symptoms are severe or worsen, or there is concern for HACE or HAPE, descent can be lifesaving; supplemental oxygen or treatment with a portable hyperbaric bag should be administered until descent occurs.^{3,6,8,11,13,14,17} Access to oxygen at higher altitudes may be limited, but, if available, patients should see a response within an hour.^8,11 Hyperbaric bags, or chambers, simulate a descent that can equate to several thousand feet.^1,8 Their advantages include portability due to their compact size and low weight.^1,8 Limitations on use include symptom recurrence once the individual is removed from the bag, and the occurrence of claustrophobia and/or vomiting. ¹¹

Pharmacologic Treatment

Pharmacologic options for AMS primarily include acetazolamide (Diamox) and dexamethasone, in addition to medications for symptomatic treatment such as analgesics and antiemetics. Acetazolamide, a carbonic anhydrase inhibitor, can alleviate acute symptoms of mild AMS by accelerating acclimatization.^1,8,11,14,18 The recommended adult dosage is 250 mg orally twice daily; in the pediatric population, the dosage is 2.5 mg/kg per dose twice daily up to a maximum of 250 mg per dose.^{1,5,8,11,13,14,16,18} Acetazolamide should not be used in people with a history of a sulfa allergy, hepatic disease or marked renal impairment, adrenocortical insufficiency, hyponatremia, hypokalemia, or metabolic acidosis.¹⁸ Common adverse effects include paresthesias (peritorbital region, hands, and feet), dysgeusia (especially with carbonated beverages), glycemic and/or electrolyte changes, diuresis, and metabolic acidosis. ^1,4,10,14,18 Elderly patients, patients with diabetes mellitus, and those taking concurrent high-dose aspirin may be more likely to experience these adverse effects.¹⁸

Dexamethasone, a long-acting corticosteroid, is an effective treatment for any degree of AMS and should be used in patients with sulfa allergy or preferentially in those with moderate-to-severe AMS.^1,8,11,14,19 The dosing for dexamethasone is 4 mg every 6 hours administered orally, IV, or IM until symptoms resolve.^{8,11,14,16,19,20} For pediatric patients, the dosage is 0.15 mg/kg per dose every 6 hours.^1,11,13,19 Although acetazolamide assists with acclimatization, dexamethasone does not, and patients may experience rebound AMS upon discontinuation.^1,4,19,20 Dexamethasone is contraindicated in patients with systemic fungal infections. It should be used cautiously in patients with cardiovascular disease, gastrointestinal disease, diabetes mellitus, psychiatric disorders, and hepatic or renal impairment. ¹⁹ Common adverse effects of dexamethasone include hyperglycemia, changes in mood, fluid retention, and dyspepsia.^14,19 Antacids may decrease the bioavailability of dexamethasone, while strong CYP3A4 inducers may decrease the serum concentrations.¹⁹ Acetazolamide and dexamethasone may be used alone or in combination.¹² If symptoms progress rapidly or descent will be delayed, then combination therapy is preferred.⁸

For symptomatic treatment, OTC analgesics (e.g., aspirin, ibuprofen, naproxen, acetaminophen) at usual dosages successfully treat AMS-associated headache.^1,8,14,16 However, opioid analgesics should be avoided in these patients because of their respiratory adverse effects. Nausea and vomiting may be treated with antiemetics such as promethazine or ondansetron. Insomnia may be treated with acetazolamide, which improves nocturnal oxygenation.^1,8

Prevention

Pharmacists may be faced with questions regarding strategies to prevent AMS. Current guidelines provide recommendations based on patient risk factors including a prior history of AMS, rate of ascent, and maximum altitudes for climbing and sleeping (see Table 2). Low-risk patients should rely solely on nonpharmacologic strategies to prevent AMS, whereas patients with a moderate-to-severe risk may benefit from both behavioral approaches and pharmacologic prophylaxis (see Table 1).¹¹

Gradual ascent is considered the most effective approach to prevent the development of AMS.⁸ Prior to ascending to higher elevations, it is recommended that patients sleep at an altitude of 1,500 to 2,500 m to help with acclimatization.^3,4,14 Those traveling above 2,500 m should ascend at no more than 300 to 600 m/day above the sleeping altitude of the previous night.^1,3,11 Adding a rest day after every 600 to 1,200 m of ascent will also assist the acclimatization process.¹ When gradual ascent is not possible, individuals may ascend faster than the recommended rate if they return to lower elevations for sleep (climb high, sleep low). Other nonpharmacologic strategies include maintaining adequate hydration, limiting activity for the first few days at higher elevations, and avoiding alcohol and other depressants.^8,14

In moderate-to-severe risk situations, acetazolamide is the preferred agent, with recommended dosing of 125 to 250 mg orally two to three times daily, preferably initiated 24 to 48 hours before ascent and continued for the first day or two at high altitude.^{1,4,8,11,14,21} Although drug prophylaxis should be avoided in children, there are cases when it may be necessary. The pediatric dosage of acetazolamide is 2.5 mg/kg per dose twice daily (125 mg/dose maximum).^11,13 For patients who are intolerant or allergic to acetazolamide, dexamethasone 8 mg daily in divided doses may be considered.^3,4,8,9,11 Duration should be limited in order to prevent glucocorticoid toxicity and/or adrenal suppression. Dexamethasone should not be used for prevention in the pediatric population. ¹¹ Although the combination of acetazolamide and dexamethasone was found to be more effective than either given alone, use of the combination should be reserved for when more severe symptoms of AMS are likely.²²

Several studies have focused on the utility of analgesics in AMS. Prophylaxis with aspirin has shown a significant reduction in the development of AMS-associated headache at a dosage of 320 mg orally taken at 4-hour intervals, starting 1 to 2 hours prior to arrival at final altitude, for a total of three doses.^23,24 In addition, ibuprofen has reduced the incidence of AMS and AMS-associated headache at a dosage of 600 mg three times daily, starting 6 to 24 hours before ascent and continuing for a minimum of three doses.^25,26

Ginkgo biloba is an herbal product that may be effective for prophylaxis of AMS. Oral dosages used in clinical trials range from 60 mg three times daily to 80 mg to 120 mg twice per day started prior to ascent. ^14,27-29 Although there is conflicting evidence regarding ginkgo’s effectiveness, the lack of a standardized preparation may partially account for the variation in results.^11,29 Current guidelines do not recommend this agent for prophylaxis; however, patients may choose to proactively initiate the medication because it is readily available OTC.

Antioxidant vitamin supplements may also be helpful in preventing AMS; however, supporting data were found only in a single clinical trial. Patients were randomized to receive antioxidant supplements (each containing ascorbic acid, tocopherol, and lipoic acid) or placebo 3 weeks prior to travel and continued while at high altitude. Although there was no significant difference in the incidence of AMS, participants given antioxidant prophylaxis demonstrated fewer AMS-related symptoms than those who were not given prophylaxis.³⁰ Additional research with larger numbers of patients is needed before this intervention can be routinely recommended. ¹⁴

Conclusion

Millions of people each year travel to areas of higher altitude. Because pharmacists are easily accessible healthcare professionals, they are uniquely positioned to assist patients who are already at their destination or are preparing to travel. Therefore, it is essential that all pharmacists are able to educate their patients on treatment options for AMS and the best available prevention strategies.

REFERENCES

1. Hackett PH, Roach RC. High-altitude illness. N Engl J Med. 2001;345(2):107-114.
2. Hackett PH, Roach RC. High altitude medicine. In: Auerbach PS, ed. Wilderness Medicine. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007.
3. Basnyat B, Murdoch DR. High-altitude illness. Lancet. 2003;361:1967-1974.
4. Fiore DC, Hall S, Shoja PS. Altitude illness: risk factors, prevention, presentation and treatment. Am Fam Physician. 2010;82(9):1103-1110.
5. Harris MD, Terrio J, Miser WF, et al. High-altitude medicine. Am Fam Physician. 1998;57(8):1907-1914.
6. Bartsch P, Swenson ER. Acute high-altitude illnesses. N Engl J Med. 2013;368:2294-2302.
7. Schneider M, Bernasch D, Weymann J, et al. Acute mountain sickness: influence of susceptibility, preexposure, and ascent rate. Med Sci Sport Exer. 2002;34:1886-1891.
8. Ellsworth A. Pharmacotherapy for altitude-related illness. J Pharm Pract. 2003;16(1):68-75.
9. Imray C, Booth A, Wright A, et al. Acute altitude illnesses. BMJ. 2011;343:411-417.
10. Plant T, Aref-Adib G. Travelling to new heights: practical high altitude medicine. Brit J Hosp Med. 2008;69(6):348-352.
11. Luks AM, McIntosh SE, Grissom CK, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med. 2014;25:S4-S14.
12. Gallagher SA, Hackett PH. High-altitude illness. Emerg Med Clin N Am. 2004;22:329-355.
13. Pollard AJ, Niermeyer S, Barry P, et al. Children at high altitude: an international consensus statement by an ad hoc committee of the International Society for Mountain Medicine. High Alt Med Biol. 2001;2(3):389-403.
14. Spooner LM, Olin JL, DeBellis RJ. Pharmacotherapy of high-altitude illness. Am J Lifestyle Med. 2007;1(2):129-141.
15. Duster MC, Derlet MN. High-altitude illness in children. Pediatr Ann. 2009;38;(4):218-223.
16. West JB. High-altitude medicine. Am J Respir Crit Care Med. 2012;186(12):1229-1237.
17. Kasic JF, Yaron M, Nicholas RA, et al. Treatment of acute mountain sickness: hyperbaric versus oxygen therapy. Ann Emerg Med. 1991;20(10):1109-1112.
18. Acetazolamide. Lexi-Comp Online. Hudson, OH: Lexi-Comp, Inc; 2017. https://online.lexi.com. Accessed June 1, 2017.
19. Dexamethasone. Lexi-Comp Online. Hudson, OH: Lexi-Comp, Inc; 2017. https://online.lexi.com. Accessed June 1, 2017.
20. Hackett PH, Roach RC, Wood RA, et al. Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med. 1988;59(10):950-954.
21. Basnyat B, Gertsch JH, Holck PS, et al. Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy trial. High Alt Med Biol. 2006;7(1):17-27.
22. Bernhard WN, Schalick LM, Delaney PA, et al. Acetazolamide plus low-dose dexamethasone is better than acetazolamide alone to ameliorate symptoms of acute mountain sickness. Aviat Space Environ Med. 1998;69(9):883-886.
23. Burtscher M, Likar R, Nachbauer W, et al. Aspirin for prophylaxis against headache at high altitudes: randomized, double blind, placebo controlled trial. BMJ. 1998;316:1057-1058.
24. Burtscher M, Likar R, Nachbauer W, et al. Effects of aspirin during exercise on the incidence of high-altitude headache: a randomized, double-blind placebo-controlled trial. Headache. 2001;41:542-545.
25. Gertsch JH, Corbett B, Holck PS et al. Altitude sickness in climbers and efficacy of NSAIDs trial (ASCENT): randomized, controlled trial of ibuprofen versus placebo for prevention of altitude illness. Wilderness Environ Med. 2012;23:307-315.
26. Lipman GS, Kanaan NC, Holck PS, et al. Ibuprofen prevents altitude illness: a randomized controlled trial for prevention of altitude illness with nonsteroidal anti-inflammatories. Ann Emerg Med. 2012;59:484-490.
27. Gertsch JH, Basnyat B, Johnson EW, et al. Randomised, controlled trial of ginkgo biloba and acetazolamide for prevention of acute mountain sickness: the prevention of high altitude illness trial. BMJ. 2004;328:797-799.
28. Chow T, Browne V, Heileson HL, et al. Ginkgo biloba and acetazolamide prophylaxis for acute mountain sickness. Arch Intern Med. 2005;165:296-301.
29. Leadbetter G, Keyes LE, Maaekstad KM, et al. Ginkgo biloba does and does not prevent acute mountain sickness. Wilderness Environ Med. 2009;20(1):66-71.
30. Bailey DM, Davies B. Acute mountain sickness; prophylactic benefits of antioxidant supplementation at high altitude. High Alt Med Biol. 2001;2:21-29.

To comment on this article, contact [email protected].

Acute high-altitude sickness | European Respiratory Society

Clinical aspects

HAPE occurs in healthy individuals at altitudes >2500–3000 m within 1–5 days after arrival [52]. It is rarely observed below these altitudes and after 1 week of acclimatisation. In many cases it is preceded by symptoms of AMS. Early symptoms include excessive exertional dyspnoea in relation to the patient’s companions, mild cough, chest tightness and reduced exercise performance. As oedema progresses, cough and dyspnoea worsen and orthopnoea develops. Gurgling in the chest and pink frothy sputum indicate advanced cases.

Examination reveals cyanosis, tachypnoea, tachycardia, mildly elevated temperature and crackles upon auscultation. As S_aO₂ plummets, signs of hypoxic encephalopathy or, in some cases, HACE may develop. Arterial blood gas and S_aO₂ measurements in advanced HAPE at 4559 m demonstrate its severity: mean P_aO₂ registered in the mid-20 mmHg range versus 35–45 mmHg in healthy controls, and S_aO₂ measurements were <50% versus 70–85% (table 1) [53]. Chest radiographs and computed tomography scans in symptomatic HAPE (figure 2) show a patchy peripheral and nodular distribution of oedema [54]. Bronchoalveolar lavage (BAL) shows a protein-rich exudate and mild alveolar haemorrhage, which initially is noninflammatory, but may progress after several days to a more inflammatory picture, as discussed later [55–57]. Echocardiographic and pulmonary artery catheterisation studies at high altitude show marked pulmonary hypertension [58–60].

FIGURE 2

a) Chest radiograph of a 37-year-old male mountaineer with high-altitude pulmonary oedema (HAPE) showing a patchy to confluent distribution of oedema, predominantly on the right side; b) computed axial tomography scan of 27-year-old mountaineer with recurrent HAPE showing patchy bilateral nodular distribution of oedema. Reproduced from [61] with permission from the publisher.

Epidemiology

Two populations are affected by HAPE. The first involves well-acclimatised alpine residents returning from low altitudes (re-entry HAPE) and the second involves rapid ascent of unacclimatised lowlanders. Altitude, ascent rate and individual susceptibility are the major determinants of HAPE. Its prevalence ranges from <0.2% in a general mountaineering population when climbing in ≥3 days to altitudes of 4000–5000 m, but as high as 7% with a single-day ascent. A similar increase in HAPE incidence of 2.5% versus 15.5% occurs when an altitude of 5500 m is reached by trekking over 4–6 days as opposed to airlift. In those with a history of radiographically documented HAPE, the likelihood of developing HAPE is 60% with a 1–2-day ascent to the same altitude [52, 53].

Pathophysiology

The pathophysiology of HAPE has been reviewed extensively elsewhere [61]. Since its recognition in the 1960s, a number of pathophysiological mechanisms have been proposed. It was clear early on that pulmonary hypertension and HAPE were inextricably linked, suggesting a primary haemodynamic basis. However, it is clear that some individuals with strong hypoxic pulmonary vasoconstriction (HPV) do not develop HAPE [62]. Thus, other factors may be necessary contributors to HAPE susceptibility. Studies suggestive of an inflammatory pathogenesis, reduced or defective active sodium and water reabsorption by the hypoxic alveolar epithelium and unevenness of regional HPV have been advanced as possibilities for how HAPE may develop.

Haemodynamics

Right heart catheterisation at high altitude revealed mean (range) pulmonary artery pressures of 60 (35–115) mmHg, but normal pulmonary artery wedge pressures [58–60]. These pioneering studies put to rest the idea that HAPE was acute left heart failure at high altitude. Excessive pulmonary artery pressures precede the development of HAPE and are not a consequence of the disease [63]. The critical role of high pulmonary artery pressure is further confirmed by the fact that descent, oxygen or drugs that lower pulmonary artery pressure are effective for prevention and treatment as discussed below.

Individuals susceptible to HAPE have many physiological characteristics that place them at greater risk. The most important is a strong HPV response, as well as higher pressures with even normoxic exercise [64, 65]. The exaggerated rise in pulmonary artery pressure in susceptible individuals developing HAPE is accompanied by increased microvascular pressure >20 mmHg, a threshold pressure for formation of alveolar oedema [59, 66].

The basis for high hypoxic pulmonary artery pressures in HAPE-susceptible subjects is multifactorial. They have lower HVR [12, 67] and stronger sympathetic tone [68]. HVR is set largely by the peripheral chemoreceptors, which results in a lower alveolar oxygen tension and higher carbon dioxide tension at the same altitude as HAPE-resistant subjects, and thus leads to a stronger stimulus for HPV [69]. Increased peripheral hypoxic chemoreceptor sensitivity also appears to reduce the strength of HPV, independent of differences in alveolar ventilation [70]. HAPE-susceptible individuals have slightly lower lung volumes and reduced diffusion capacity [12, 71, 72].

In addition, there are differences in the vasculature. Nitric oxide (NO) and endothelin-1 are important pulmonary endothelial-derived vasodilator and vasoconstrictor mediators. Endothelin production is greater in HAPE susceptibility [73], while lung NO production is reduced [56, 74, 75]. Systemic vascular endothelial NO generation is reduced more in hypoxic HAPE-susceptible subjects compared to controls [76]. This is probably also the case for the pulmonary circulation, as the above-cited measurements of exhaled NO and metabolites of NO in lavage fluid suggest.

The question arises how hypoxic constriction of pulmonary vessels leads to oedema. Three mechanisms have been suggested [53]: 1) transarteriolar leakage with oedema occurring upstream of the microvasculature at small weaker arteriolar right-angle branches off larger pulmonary arteries; 2) heterogeneous regional arterial hypoxic vasoconstriction; and 3) hypoxic venoconstriction. If arterial vasoconstriction in hypoxia is inhomogeneous, HAPE could be the consequence of higher flows in those areas with lesser vasoconstriction, leading to increased microvascular pressure. MRI of lung blood flow demonstrates that HPV is uneven at rest in susceptible individuals [77, 78], but not in those with proven HAPE resistance. This unevenness in regional HPV may help to explain the characteristic patchy and nodular appearance of oedema in HAPE.

The reason(s) why the pulmonary vasculature leaks under high pressure are not completely resolved. Traditionally, pulmonary oedema has been categorised as either noncardiogenic (increased permeability with exudative characteristics: high protein concentrations and markers of inflammation in the setting of normal or only modestly elevated intravascular pressures) or cardiogenic (elevated hydrostatic pressures leading to a noninflammatory protein-poor transudative leak). As described above, BAL fluid in nascent HAPE [56] reveals characteristics of a hydrostatic, but noncardiogenic noninflammatory oedema suggesting pressure-induced alterations to the normal permeability of the alveolar–capillary barrier or frank traumatic injury; the latter has been termed capillary stress failure [79].

If hydrostatic forces persist, then gene upregulation and transcription of collagen and other extracellular matrix proteins are initiated to strengthen the alveolar capillary barrier [80] and ultimately reduce stress failure and leak. These observations offer an explanation for the rapid recovery from HAPE and the protection from recurrence when re-ascending only several days after recovery from HAPE.

Inflammation

The first measurements of alveolar lavage fluid in mountaineers [55, 57] were obtained in those with established HAPE. In addition to the high protein concentrations, some, but not all cases had significant neutrophilia and elevations of pro-inflammatory cytokines and neutrophil chemotactic factors. These observations strongly suggested that inflammation might be a causal factor in HAPE, leading to a greater permeability of the lung microvasculature. However, not all cases of HAPE had evidence of inflammation [55], indicating that in humans inflammation is possibly a secondary response to alveolar–capillary barrier disruption or oedema. BAL in HAPE-susceptible climbers showed mild alveolar haemorrhage and increased serum-derived protein concentrations within a day of ascent to 4559 m from low altitude both in subjects ill with HAPE at the time of bronchoscopy and in those who developed HAPE in the next 24 h [56]. There is a strong correlation between the magnitude of pulmonary hypertension assessed by echocardiography and the degree of haemorrhage and protein elevation in the alveolar space (figure 3). In contrast, there were no increases in alveolar macrophages, neutrophils and pro-inflammatory mediators at high altitude early in the course of HAPE.

FIGURE 3

Individual bronchoalveolar lavage a) red blood cell counts and b) albumin concentrations plotted against pulmonary artery systolic pressures at high altitude (4559 m). Reproduced from [56] with permission from the publisher.

It is not clear what initiates the secondary inflammation. It may be that sustained and increasing high pressures of sufficient duration in untreated HAPE can trigger inflammation [81], or it represents part of the healing process of a markedly disrupted alveolar–capillary barrier that occurs in the most severe cases of HAPE, especially with alveolar haemorrhage, since haem and other breakdown products of red cell haemoglobin are chemotactic for neutrophils [82]. Despite overwhelming evidence against a primary inflammatory alteration of the alveolar–capillary barrier in HAPE, it is nevertheless conceivable that any concurrent process altering the permeability of the alveolar–capillary barrier will lower the pressure required for formation of oedema. Indeed, increased fluid accumulation during hypoxic exposure after priming by endotoxin or virus in animals [83, 84] and the association of preceding respiratory viral infections with HAPE in children [85, 86] support this concept. Thus, upper respiratory tract infections shortly before a sojourn in the mountains and vigorous exercise at altitudes between 2000 and 3000 m may explain in some cases why HAPE can develop at a modestly low altitude [87].

Alveolar fluid clearance

Disruption of the alveolar capillary barrier and leak are the proximal causes of HAPE, but studies have highlighted the possibility that alveolar fluid clearance mechanisms dependent upon active alveolar epithelial sodium and water reabsorption by type I and II pneumocytes may contribute to the pathophysiology of HAPE. Active fluid transport from the alveolar space into the lung interstitium and clearance via lymphatics is important in normal lung fluid balance. Hypoxia decreases transepithelial sodium transport by reducing expression and activity of the epithelial sodium channel (ENaC) and sodium (Na⁺)/potassium (K⁺) ATPase proteins [88], possibly by an impairment of β₂-adrenergic receptor signalling [89]. In vivo hypoxia depresses alveolar fluid clearance in hypoxic animals [90, 91]. Mice partially deficient in ENaC develop greater accumulation of lung water in hypoxia [92].

Another approach to study the relevance of alveolar transepithelial fluid reabsorption in HAPE has involved the use of β₂-receptor agonists and glucocorticoids, both of which upregulate ENaC and Na⁺/K⁺ ATPase [93]. Two field studies reported successful prevention of HAPE in HAPE-susceptible climbers with inhalation of salmeterol, a long-acting β₂-agonist [94], and oral dexamethasone [95] begun 1 day before ascent. Owing to multiple actions of β₂-adrenergic agonists, such as inhibition of HPV, increased HVR and ventilation, tightening of cell-to-cell contacts and upregulation of NO production [96], the contribution of enhanced alveolar fluid clearance remains uncertain. Indeed, the protective effect of dexamethasone from a putative enhancement of alveolar fluid reabsorption could not be correlated with indirect measures of enhanced active sodium reabsorption, but rather to a surprising reduction of pulmonary artery pressure [95].

ACUTE MOUNTAIN SICKNESS | Sports Medicine Today

What is it?

Acute mountain sickness pertains to group of symptoms that can occur when one quickly gains altitude, like when traveling to the mountains to hike or ski. This condition usually occurs at altitudes above 2500 m (8200 ft), but can affect people at altitudes as low as 2000 m (6500 ft). It is caused by the smaller amount of oxygen available to breathe at higher altitudes.

Symptoms

The most comon symptom of acute mountain sickness is headache, but nausea, vomiting, dizziness, fatigue, and insomnia (inability to sleep) are also common.

Sports Medicine Evaluation

A physician suspicious of acute mountain sickness will ask questions to assess mental function, as well as listen to breath sounds with a stethoscope. This examination is primarily to determine if a more severe altitude illness, such as high-altitude pulmonary edema (increased fluid in the lungs) or high-altitude cerebral edema (increased water in the brain) is present.

Sports Medicine Treatment

The most appropriate treatment for mild symptoms of acute mountain sickness is stopping further climbing, or ascent, and resting. If symptoms worsen or fail to improve by 24 hours, descent, or moving to a lower altitude by 500-1000 m should occur. For mild symptoms, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or acetazolamide (125-250 mg twice/day), may help. For more severe symptoms, rapid descent is recommended, and steroids may be prescribed.

Injury Prevention

Most acute mountain sickness episodes are preventable. Rapid change in altitude should be avoided. Altitude change should be less than 500 m per night. In addition, for every 1000 m ascent, it is recommended that the traveler spend two nights at the same altitude. Travelers who have a previous history of acute mountain sickness should follow more conservative guidelines, such as 300 m per night. Medications, including NSAIDs and acetazolamide, can be prescribed in some cases to help prevent acute mountain sickness. A proper diet that includes adequate carbohydrate intake and fluid consumption may increase exercise tolerance at altitude, but does not reduce the risk of developing acute mountain sickness. In general, being in good shape does not decrease the risk of developing acute mountain sickness.

Return To Play

If symptoms of acute mountain sickness resolve with rest or descent, a slower ascent can be attempted. Taking NSAIDs or acetazolamide prior to and during ascent may help to prevent future occurrences.

AMSSM Member Authors: Mark Kasmer, MD, Matt Gammons, MD

References

Brukner P, Khan K. Brukner & Khans Clinical Sports Medicine. 4th Edition. Australia: McGraw-Hill Education; 2012.

Brtsch P, Swenson ER. Clinical practice: Acute high-altitude illnesses. N Engl J Med [Internet]. 2013 Jun 13 [cited 2014 Sep 6];368(24):2294302. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23758234.

AMSSM is a multi-disciplinary organization of sports medicine physicians dedicated to education, research, advocacy and the care of athletes of all ages. The majority of AMSSM members are primary care physicians with fellowship training and added qualification in sports medicine who then combine their practice of sports medicine with their primary specialty. AMSSM includes members who specialize solely in non-surgical sports medicine and serve as team physicians at the youth level, NCAA, NFL, MLB, NBA, WNBA, MLS and NHL, as well as with Olympic teams. By nature of their training and experience, sports medicine physicians are ideally suited to provide comprehensive medical care for athletes, sports teams or active individuals who are simply looking to maintain a healthy lifestyle. Find a sports medicine physician in your area at www.amssm.org.

Altitude Disease – an overview

Clinical Presentation and Diagnosis

AMS is a syndrome of nonspecific symptoms and a broad spectrum of severity. AMS occurs in nonacclimatized persons in the first 6–24 hours after ascent to altitudes >2500 m, especially after rapid ascent (≤1 day). Symptoms usually begin a few hours after arrival at the new altitude, but may arise a day later (often after the first night’s sleep). The cardinal symptom is headache, typically bifrontal and throbbing. Gastrointestinal symptoms (anorexia, nausea, vomiting) and constitutional symptoms (weakness, lightheadedness, lassitude) are common. AMS is thus similar to an alcohol hangover or a nonspecific viral infection, but without fever and myalgia. Diagnosis of AMS requires a recent gain in altitude, at least several hours at the new altitude, and the presence of at least two of the typical symptoms: headache, gastrointestinal upset (anorexia, nausea, vomiting), fatigue or weakness, dizziness or lightheadedness, and difficulty sleeping.¹⁶ An additional part of the Lake Louise criteria is the clinical function score (CFS). This is based on the patient’s response to a single question, “Overall, if you had any symptoms, how did they affect your activity?” Scoring is from 0–3 for no reduction in activity to mild, moderate, or severe reduction (e.g., bedrest). A CFS score ≥2 (moderate to severe reduction in activity) indicates AMS. A recent meta-analysis comparing a variety of diagnostic questionnaires used to assess for AMS found that they all performed comparably in identifying AMS, but the CFS is the simplest to use in clinical and travel environments.¹⁷

Fluid retention is characteristic of AMS and victims often report reduced urination, in contrast to the spontaneous diuresis observed with successful acclimatization. As AMS progresses, the headache worsens, then vomiting, oliguria, and increased lassitude develop. Ataxia and altered level of consciousness herald the onset of clinical HACE (Fig. 42.2).

Patients with AMS appear ill but lack characteristic physical findings, as with hangover. Heart rate and blood pressure are variable and nondiagnostic. Unless HACE is present, neurologic examination is normal. Fundoscopy may reveal retinal hemorrhages, but these are not specific to AMS. Pulmonary crackles may be present, but oxygen saturation will be normal or at most slightly lower than acclimatized persons at the same elevation. Peripheral and facial edema may be present, particularly in women.

Most conditions similar to AMS can be excluded by history and physical examination. Onset of symptoms >3 days after ascent, lack of headache, or failure to improve with descent, oxygen, or dexamethasone suggests another diagnosis. Dehydration is commonly confused with AMS, as it can cause headache, weakness, nausea, and decreased urine output.

The natural history of AMS varies with altitude, ascent rate, and other factors. In general, symptoms improve slowly, with complete resolution in 1–2 days. AMS symptom duration ranged from 6 to 94 hours with a mean of 15 hours in one study at 3000 m.¹⁸ A small percentage (<10%) of persons with AMS will go on to develop HACE, especially with continued ascent in the presence of AMS symptoms. Whereas AMS has no characteristic physical findings, HACE is an encephalopathy and is characterized by gait ataxia, severe lassitude, and altered consciousness.

Untreated, HACE may progress to stupor and coma over hours to days, and death is due to brain herniation. Ataxia commonly persists for days to weeks after descent, but persistent mental status changes or the presence of focal neurologic deficits should prompt a complete neurologic evaluation. Brain tumors that suddenly become symptomatic at altitude,¹⁹ Guillain-Barré syndrome, severe hyponatremia, and cortical blindness have all been misdiagnosed as HACE. The typical MRI finding of increased T2 signal in the corpus callosum acutely, or evidence of hemosiderin deposits on T2*, or susceptibility weighted imaging (SWI) sequences even years later will confirm the diagnosis. Patients who survive typically have full recovery after descending, but reports of persistent neurologic sequelae exist.

90,000 Commonly used drugs for the prevention of altitude sickness

Relevance

Altitude sickness (ALS) is a term used to describe a group of pathological conditions in the brain and respiratory system that develop during travel at an altitude of more than 2500 meters (8202 feet) above sea level. Common manifestations of IB are headache, nausea, vomiting, and general fatigue (often referred to as acute mountain sickness), but some people may have brain or lung abnormalities.In this review, we evaluated medications commonly used to prevent the onset of this disease.

Research characteristics

Evidence is current to January 2017. The review included 64 studies of six different types of drugs recommended for the prevention of WB. Most of the studies were conducted in high altitude areas, while the rest used low pressure chambers (hypobaric) to simulate exposure to high altitudes.The age of the study participants ranged from 16 to 65 years. Eleven studies included people at high risk of developing altitude sickness due to a history of episodes of WB or other illnesses such as asthma. In thirty-four trials, interventions were performed three to five days before climbing, and in 23 trials, one to two days. In most of the included studies, the resulting elevation ranged from 4001 to 5000 meters above sea level. The funding sources for the 23 included studies were unclear.Only 18 studies reported a possible conflict of interest. We classified another 24 studies as pending or pending.

Highlights

Our results suggest that acetazolamide is effective in the prevention of acute WB at doses ranging from 250 to 750 mg per day, compared to placebo (i.e., tablet without active substance). Most of the information available relates to the prevention of uncomplicated IBD (headache, nausea, vomiting, and fatigue) rather than more serious brain and lung problems.We also found that acetazolamide use was associated with an increased risk of paresthesia in the fingers (i.e., tingling, tingling, or burning sensations of the skin), although this outcome was not well represented in the available data. The benefits and harms of other drugs, such as ibuprofen, budesonide, and dexamethasone, are unclear due to the small number of relevant studies.

Quality of evidence

We rated the quality of the evidence as moderate to very low.Some studies had quality gaps, including a small number of participants and a lack of information on important outcomes such as side effects. For most of the drugs studied in these studies, more research is needed to determine their effectiveness and safety.

Altitude sickness or altitude sickness.

General.

Altitude sickness (or altitude sickness) can be caused by a sharp rise of a person upward, due to which the body does not have enough time to adapt to a low oxygen content and changes in air pressure.

Symptoms include headaches and vomiting. Mountain sickness can be very harmful to the body, even fatal.

Climbers are more at risk of developing altitude sickness (also known as mountain sickness), which can be harmful or even fatal if the onset is ignored.

This is due to the fact that the body, gaining altitude too quickly, does not have time to adapt to the oxygen content and changes in air pressure, and causes hypobaric hypoxia (lack of oxygen supplied to the tissues of the body).In severe cases, fluid accumulates in either the lungs, the brain, or both.

At intermediate altitudes (1500 to 2500 meters above sea level), altitude sickness is unlikely, but possible. An exacerbation of altitude sickness occurs after four or more hours spent by a person at an altitude of more than 2000 meters. Being at altitudes over 2,500 meters can cause a variety of symptoms, including headaches and vomiting. Men are, for unknown reasons, more susceptible to altitude sickness than women.

It is important to remember that youth and good athletic training will not reduce the risk of illness, and the fact that you have never suffered from altitude sickness does not mean that you are insured against it during future ascents. The only preventive measure is to extend the ascent time for better adaptation.

Symptoms of altitude sickness.

Early symptoms of altitude sickness may include:

* Headache.

* Lethargy.

* Decrease in activity.

* Poor coordination.

* Insomnia.

* Loss of appetite.

* Dizziness.

* Nausea.

* Vomiting.

Severe form of altitude sickness.

There are two main types of severe altitude sickness: high-altitude pulmonary edema (fluid in the lungs) and high-altitude cerebral edema (fluid in the brain).In most cases, both conditions occur simultaneously. A person with pulmonary edema may choke if the lungs are filled with large amounts of fluid.

Symptoms of severe mountain sickness include:

* Shortness of breath.

* Rapid heartbeat.

* Blue tint of skin and nails due to lack of oxygen (cyanosis)

* Frequent cough and fluid in the lungs.

* The sputum can be frothy or bloody due to damage to the lung tissue.

* Irrational behavior such as refusing to acknowledge symptoms.

* Inability to walk in a straight line.

Prevention of altitude sickness.

The best way to prevent altitude sickness is to climb slowly. Once you have reached an altitude of over 3000 meters above sea level, move at a speed of no more than 300 meters per day. Be sure to take a break for rest and acclimatization after climbing 1000 meters.

Other ways to prevent altitude sickness include:

* Consult your doctor for advice and useful information before traveling.

* Some climbers find that switching to a high-carbohydrate diet before the hike can help reduce risk.

* Get ready. Pack all necessary first aid items, including medicines.

* There is evidence of the effectiveness of acetazolamide.This is especially useful if you are climbing quickly and do not have time to acclimatize. Inhalers are used to prevent fluid buildup in the lungs.

* Remember that drugs like nifedipine and dexamethasone are best used to treat mild disease rather than prevent altitude sickness. These drugs can mask and hide the initial symptoms.

* Climb only with experienced guides.

* Increase your fluid intake.You may need up to seven liters a day.

* Avoid cigarettes and alcohol.

* Do not use sleeping pills, as they can lead to increased hypoxia. This is due to the depressing effect of the drug on the central nervous system.

* Know that you are at increased risk of altitude sickness if you have experienced it before.

First aid for altitude sickness.

Use the help of people around you, because you will most likely refuse to accept your symptoms.This is not uncommon for injured climbers who are stubbornly reluctant to descend. If one of your squad is showing signs of altitude sickness, first offers of help should include:

* Don’t go any higher, stay in the camp and wait for the symptoms to subside. This may take several days.

* Make sure the person avoids alcohol and cigarettes.

* Give him aspirin or paracetamol at the usual recommended dose.

* Deep breathing every few minutes will lower the level of carbon dioxide in your blood.

* Give the patient the recommended dose of dexamethasone.

* In case of a severe case of illness, immediately descend. Aim for a descent of 500 to 1000 meters.

* Give the person a diuretic to reduce the risk of fluid accumulation.

* Oxygen supply from a portable oxygen cylinder.

Treatment of altitude sickness with hyperbaric oxygenation (oxygen therapy).

Hyperbaric Oxygen Therapy uses specially designed chambers or rooms that can withstand high pressures. Air above sea level contains 21 percent oxygen, while hyperbaric oxygen therapy can provide up to 100 percent pure oxygen.

This form of therapy oxygenates the body and relieves the symptoms of altitude sickness. A portable oxygen cylinder delivers oxygen, which is regulated through a face mask or hood.Never use oxygen therapy or altitude sickness medications to continue climbing if symptoms of illness have already occurred. The result can be fatal.

Where to get help:

* Your doctor.

Points to remember:

* Climbers are at risk of developing altitude sickness.

* Altitude sickness is caused by the fact that the body, gaining altitude too quickly, does not have time to adapt to the oxygen content and changes in air pressure.

* Symptoms include headache, vomiting, insomnia, and decreased activity and coordination.

* In severe cases, fluid accumulates either in the lungs, or in the brain, or in both organs. This can lead to death.

* First aid options include lowering altitude, administering medication, and using oxygen supplied through a portable container.

You may find the following articles helpful:

90,000 Research: climbing mountains causes mental changes

Mysterious voices, strange visions and a sense of the presence of someone else are faithful companions of climbers climbing to great heights.Scientists have found that these hallucinations are not associated with physiological changes in the body and, apparently, are caused by the psyche.

Climbers climbing to an altitude of more than 7000 m often encounter various hallucinations. Both visual hallucinations and auditory hallucinations are common – climbers notice movement where there is none, hear music or voices. And more often those who climb the mountain alone face this.

For example, the Austrian climber Hermann Buhl, who was the first to conquer the 8126 meter high Nanga Parbat peak in the northwest of the Himalayas – the ninth largest peak in the world, nicknamed the “killer mountain” because 31 climbers died while climbing it – on the way back suddenly I discovered that he had a company, although he climbed to the top alone: “At Zilbersattel, I saw two points.And he almost screamed with joy: someone was coming up.

I heard voices, someone called “Herman!” The disappointment was bitter. Depressed, I set off again. Such realizations happened often. Then I heard voices, clearly heard my name – hallucinations. ”

Another type of hallucinations is so widespread that it has a separate name – the factor of the third person. With it, climbers have the feeling that there is someone else on the mountain besides them.

This type of hallucination is characteristic not only of climbers – for example, polar explorer Sir Ernest Shackleton wrote about a similar experience during an expedition to Antarctica in 1914. The report featured a certain fourth, who accompanied three members of the expedition.

“It often seemed to me that there were four of us, not three,” Shackleton wrote.

American pilot Charles Lindbergh gave similar evidence. During his famous transatlantic flight, he felt as if he was not alone in the cockpit: “The fuselage behind me was filled with ghostly creatures – vague silhouettes, transparent, moving, weightlessly traveling with me on the plane,” he wrote.- Their appearance did not surprise me. There was no surprise in him … Without turning my head, I saw them as clearly as in the usual field of vision. ”

In The Third Man Factor, writer John Geiger lists conditions associated with perceived presence:

monotony, darkness, bare landscape, isolation, cold, injury, dehydration, hunger, fatigue and fear.

For a long time, “factor three” was associated with altitude sickness, which occurs due to oxygen starvation.Symptoms include dizziness, nausea, insomnia, bleeding in the eyes, and, in severe cases, cerebral and pulmonary edema. A type of altitude sickness is mountain sickness, in the occurrence of which physical fatigue, dehydration, hypothermia, sudden changes in temperature, and severe weather conditions also play a role. Yet oxygen starvation remains the main pathological factor.

Experts from the Eurac Research Center in Italy and the Leopold and Franz University of Innsbruck in Austria believe that hallucinations are not a consequence of oxygen deprivation and arise independently of it.The researchers presented their findings in an article in the journal Psychological Medicine .

They reviewed 83 episodes of hallucinations in climbers and examined the accompanying symptoms.

“In our study, we found that there is a group of symptoms that are purely psychotic,” says Hermann Brugger, one of the authors of the work. –

That is, although they occur at high altitudes, they cannot be attributed to organic factors such as cerebral edema, fluid loss or infections. “

However, scientists cannot say with certainty the reason for the hallucinations. They suggest that the appearance of an apparent “third” may be associated with loneliness or being in a small group or difficult climbing conditions. Upon returning to a safe altitude, hallucinations are known to subside and have no lasting effects.

“This discovery allows for a more thorough study of transient psychoses in healthy people, which may provide clues to understanding the nature of mental illness, such as schizophrenia,” – said study co-author Katharina Hüfner.

Also, the results of the study will allow climbers to better prepare for the ascent and draw up a plan of action in case they have to deal with high-altitude psychosis.

In addition, researchers can try to reproduce the results in a laboratory setting using chambers with low pressure and oxygen content.

Next year, the team, in collaboration with experts from Nepal, is going to more accurately assess the frequency of psychosis, as well as clarify the factors of their occurrence and potential risks.

90,000 Dangers when climbing Elbrus

Although the routes to Elbrus are considered safe enough among climbers, nevertheless we are talking about climbing the highest mountain in Europe. It is not surprising that, according to unofficial statistics, about 15-20 people die on its slopes every year. Sometimes it is the seeming simplicity that turns out to be fatal for some tourists. Despite the fact that all routes have long been paved and passed thousands of times, there are a number of dangers to be aware of.

Weather unpredictability

Elbrus is insidious in that it is very difficult to predict the weather on its slopes. It is important not to forget that we are talking about a separately located mountain, which has a climate independent of the surrounding areas. For example, a warm mass of air can break through the Caucasian ridge at any moment, which will cause a thunderstorm around the summit. It is useless to search for information about this on the websites of the Hydrometeorological Center.

There is only one way out – to act according to the situation.The team leader should always have a plan “B” in stock. In case of bad weather, you need to stop moving up and go down to the base shelter. According to statistics, 70% of those killed on Elbrus became victims of disorientation in conditions of poor visibility. The saddle is especially dangerous in this respect: it is almost impossible to survive on it in bad weather. Gusty winds of up to 200 km / h interfere with the installation of domed shelters there.

Hypothermia

On a mountain with a height of more than 5000 m, even in summer there is a subzero temperature, dropping at night to values of -40 degrees.No wonder there are special recommendations for special warm clothing. The temperature drops gradually. In the Caucasus region, this is 7-10 degrees for each meter of rise.

Altitude sickness

One of the most important dangers of Elbrus, lying in wait for mostly irresponsible tourists. During the ascent, you need to monitor your well-being. There will be nothing shameful if the person comes back. Better to do so than to be at altitude with acute manifestations of altitude sickness.A special responsibility in this respect rests with the guide or group leader.

Upon detection of moderate and severe attacks of altitude sickness (begins to hurt a lot and dizzy, shortness of breath appears, the pulse becomes rapid), the person must be urgently lowered down. Diuretics and aspirin relieve symptoms. However, the best prevention is the correct passage of acclimatization, when the body gradually gets used to new conditions for itself within 7-10 days.

Dehydration

It should be remembered that already at the 2000 m mark, the amount of moisture in the air drops by about half. With further rise, the situation is aggravated: at a considerable altitude, the air is almost “dry”. As a result, the body begins to rapidly lose moisture through the skin and during respiration. To protect yourself from dehydration (and, as a result, a sharp decline in strength), it is necessary to debug a suitable drinking regime.

Adequate water intake is also a good prevention against altitude sickness.Moisture performs an essential function in the physiological processes of the human body, accounting for approximately 70% of its mass. Under normal conditions, you should drink at least 2.5 liters of water per day. In conditions of altitude, the consumption rate increases to 3.5-4.5 liters. At altitude, it is better to drink liquid under the guise of hot sweet tea. Therefore, a high-quality thermos is indispensable for a hike.

Solar radiation

Due to a decrease in the concentration of oxygen and moisture in the air at altitude, the voltage of the sun’s radiant energy increases noticeably.Measurements have shown that this figure increases by 10% / 1000 m ascent. Particularly to be wary of ultraviolet radiation, the increase in intensity of which occurs in the ratio of 4% / 100 m rise.

Excessive exposure to solar radiation can cause burns, sunstroke, disorders of the nervous and cardiovascular systems, etc. Due to intense ultraviolet radiation, some tourists begin to inflame the corneas of the eyes. Therefore, the composition of the required attributes of the climber includes protective creams, goggles and a mask.

Differential pressure

While climbing the mountains, a person also feels a drop in atmospheric pressure. Compared to normal conditions, the difference in this indicator on Elbrus can reach 40%. Because of this, symptoms of the aforementioned altitude sickness may appear. The recipe is the same – the obligatory passage of soft acclimatization, with test nights at an altitude of 3-4 km.

People with hypertension, heart disease, problems with blood vessels in the mountains are allowed to go only after consulting a doctor.Perhaps the “climbing with oxygen” program is more suitable for them, when the tourist is provided with a special oxygen mask. The hike itself in this case is reduced to 1 day.

90,000 In 2019, the insurance company “Soglasie” organized 9 rescue … – July 1, 2019 | INSURANCE TODAY

In 2019, the Soglasie insurance company organized 9 rescue operations in the mountains using helicopters

Europe (in Italy, Switzerland, Andorra, France), one in Tanzania, four more in Nepal.

So, in particular, in March 2019, two forty-year-old Russian tourists were on vacation in Tanzania and climbed the highest stratovolcano in Africa – Kilimanjaro. On the fourth day in the mountains, they developed symptoms of altitude sickness (shortness of breath, headache, hemoptysis). The insurance company urgently organized the evacuation of tourists by helicopter with the involvement of the local rescue service to the clinic, where they received the necessary medical assistance.

In May 2019, in Nepal (Everest, 8848 m), at an altitude of 4800 meters, one of the tourists developed altitude sickness. Her condition did not allow her to continue the journey with the group. The insurance company organized a medical evacuation of the insured by helicopter to a specialized clinic that treats such patients using pressure chambers and oxygen equipment. After providing the necessary assistance, the patient was safely discharged from the clinic.

Similar cases occur mainly in Nepal: the insured are often trekking on the slopes of Everest.At an altitude of over 4000 m, untrained hikers almost inevitably develop symptoms of altitude sickness. This year, the insurance company “Soglasie” organized helicopter evacuations from heights of 4200 m, 4800 m and once from an altitude of 8000 m. route and heights to which it is planned to climb (up to 5000 m, more than 5000 m, more than 8000 m), as well as types of recreation – winter sports or extreme sports, since different types of policies include different coverage.

Treatment of the musculoskeletal system in the sanatorium “Victoria”, Kislovodsk, Stavropol Territory

Therapy of diseases of the musculoskeletal system is one of the key areas of the Victoria sanatorium. The reason for this is the prevalence among adults, athletes and the early development of pathologies in young people.

Relevance

The musculoskeletal system is the bones that hold them together, the cartilages that reduce their friction against each other, and also the muscles that move all these joints.If at least one of these structures is damaged (this is manifested by inflammation, swelling, dysplasia or a degenerative process) pain appears, the ability to perform a number of movements suffers. Diseases of the musculoskeletal system take on a chronic course and can gradually lead to a complete loss of performance. To prevent this from happening, you need to treat them correctly and in a timely manner.

Who is this program for

The specialists of the Victoria sanatorium have accumulated knowledge and experience in the treatment of the musculoskeletal system.This allows you to reduce the severity or avoid the development of symptoms such as:

back or limb pain
decrease in range of motion, joint stiffness
headaches
limb numbness
muscle weakness
forced pose
stoop
crunch in joints

Duration : from 14 days.

Expected effect :

Pain relief or relief
Normalization of general metabolic processes in the body, including cholesterol levels, blood sugar
Increase in general motor activity
Prevention of risk factors, weight loss, transfer to a new healthier diet and exercise regimen
Improving general well-being, increasing immunity
Obtaining qualified individual advice and skills on the further lifestyle, motor and nutritional regimen.

Treatment

Sanatorium “Victoria” has great potential for the treatment of diseases of the musculoskeletal system.

Healing baths – narzan, coniferous-salicylic, turpentine, sulfuric baths, etc. They restore the work of the musculoskeletal system, acting gently and sparingly.

Healing showers provide improved nutrition in tissues, relieve muscle tension, promote lymphatic drainage and weight loss.

Mud therapy – the most effective method in the fight against diseases of the musculoskeletal system. The Victoria sanatorium uses mud from Lake Tambukan, known for its unique healing properties. Mud applications allow amino acids, hormone-like biologically active substances and microelements to penetrate into tissues, providing a powerful anti-inflammatory and analgesic effect.

Physical rehabilitation – an important factor in the treatment of diseases of the spine and joints.It is carried out under the constant supervision of the attending physician and an experienced exercise therapy instructor. It allows you to gradually increase the volume and variety of physical activity, instill healthier habits, which most patients of the sanatorium continue to develop at home after returning from the sanatorium.

We use the following physical rehabilitation methods:

terrenkury – dosed walks in mountainous terrain;
Exercise therapy – individually selected physical exercises;
doing exercises in the pool
training sessions.

When purchasing a voucher for the treatment of the musculoskeletal system, please note: consultation with a chiropractor, complete blood count are already included in the price.

Manual therapy – the overwhelming majority of diseases of the musculoskeletal system are treated with the help of manual therapy – a procedure in which the effect on tissues is performed with the help of the doctor’s hands, performing certain manipulations with them in the required sequence.

In the Victoria sanatorium, a chiropractor has been working for many years using his own method, which has proven its effectiveness, in addition, it does not imply painful effects (twisting, pressing on pain points).

Our chiropractor works from Monday to Friday, working hours from 8.00 to 16.00. Initial consultation with a specialist is included in the price of the voucher.

General cryotherapy – one of the most effective procedures for pathologies of bones and joints, it maximizes the mobilization of the body’s defenses and improves the blood supply to the muscular-articular structures.General cryotherapy is an almost exclusive procedure for Kislovodsk, few medical institutions carry it out.

Carboxytherapy is another unique method of treatment for the region, which has been introduced into the medical base of the Victoria sanatorium. The procedure activates tissue respiration, regenerative forces, and leads to the destruction of adhesions.

Benefits of treatment of the musculoskeletal system in Kislovodsk

Treatment of the musculoskeletal system in the sanatorium of the Stavropol Territory is one of the main directions.In our health resort you can receive effective treatment for this profile. The healing process includes therapeutic baths, showers, mud therapy and other physiotherapy. It is worth paying attention to physical rehabilitation. Our qualified narrow-profile specialists first select the most suitable treatment for damaged areas of the musculoskeletal system, after which, under the strict supervision of a doctor and exercise therapy instructor, their normal function is restored. Adaptation of the body to stress is carried out through dosed walks in mountainous terrain, individually selected physical exercises, exercises in the pool and on simulators.We also recommend a course of manual therapy.

Victoria is a well-known sanatorium in Kislovodsk with treatment of the musculoskeletal system. For many years we have been successfully treating and rehabilitating diseases in this area. The Victoria sanatorium is a multi-profile one. We are not only a sanatorium for the musculoskeletal profile, our specialists work in many directions, which makes it possible for our guests to receive professional advice, as well as versatile and high-quality treatment of diseases of the organs of the musculoskeletal system throughout the rest.

90,000 what medicines to take and how to bring them abroad

A properly assembled first-aid kit on the road can save a vacation, and it is as necessary a thing as a passport and a bank card. But the first-aid kit raises much more questions. What must be taken, and what can you do without? How to transport medicines across the border? How to buy the required drug in another country and not overpay for branded drugs?

Skyscanner has compiled a list of a first aid kit for the trip, which includes everything you need and does not take up much space in your luggage.Learn about all the intricacies of collecting a first-aid kit at sea and on any other vacation and keep in mind a list of medicines that you should always have with you.

Remember that a first aid kit on the road will help with a slight discomfort, but does not replace the need to see a doctor. When traveling, follow all safety precautions (here are the WHO recommendations for a pandemic), and if you feel unwell, seek medical help.

These are challenging times for travel.And as the world prepares to reopen in 2021, we stay close to keep you dreaming and planning new adventures – whether it’s a short getaway close to home or a flight to uncharted corners of the planet. The latest news on tourism amid COVID-19 will help you stay on top of what’s happening and don’t miss the moment when it’s time for your next trip.

First aid kit on the road: all the subtleties of collection

What medicines to take in a travel kit: minimum required

A first aid kit on the road is akin to insurance: you hope it won’t come in handy, but you take it anyway – it’s safer.And then you take it home unpacked. For those who are not ready to carry half a suitcase of medicines, but also do not want to run a little on a trip to pharmacies, we have compiled a first aid kit for one person for two or three weeks .

Our list includes only basic remedies for emergency use and treatment of common ailments – in accordance with WHO recommendations. This is a minimal set for a quiet rest, in which, if anything, there will be an opportunity to see a doctor or look into a pharmacy.It is not suitable for hikes and long road trips to the ends of the earth.

We give Russian analogues of medicines: they contain the same active ingredient, but are much cheaper.

First aid kit for one adult on a quiet vacation for 2-3 weeks
Name and how much to take	How to Apply	Substance and cheap analogue
Nurofen Pain reliever, antipyretic 20 tablets (200 mg)	1 tablet after meals 3-4 times a day.The dose can be increased to 400 mg 3 times a day.	Substance: Ibuprofen Analog: Ibuprofen
No-shpa For muscle spasms 6 tablets (40 mg)	1-2 tablets 2-3 times a day.	Substance: Drotaverine Analog: Drotaverin
Polysorb MP Sorbent: for food poisoning 10 sachets (3 g)	Mix 1 rounded tablespoon (2.5–3 g) with 100–150 ml of water.The powder is not taken orally dry, only in the form of an aqueous suspension.	Substance: Colloidal silicon dioxide Analogue: Activated carbon (another group of sorbents)
Mezim forte Digestive enzyme: for overeating, abdominal heaviness, bloating 10 tablets	1-2 tablets before meals with water. With meals, you can take another 1-4 tablets.	Substance: Pancreatin Analogs: Pancreatin, Penzital
Cerucal With vomiting, including interfering with medication 5 tablets (10 mg)	1 tablet 30 minutes before meals with water, 3-4 times a day.	Substance: Metoclopramide Analog: Metoclopramide
Imodium For diarrhea 6 tablets (2 mg)	Tablets are sucked on the tongue. The initial dose is 2 tablets (4 mg), then 1 tablet after each episode of diarrhea.	Substance: Loperamide Analog: Loperamide
Chlorhexidine, plaster, bandage, cotton pads Antiseptic for wound treatment 50 ml plastic bottle	Can be substituted for Chlorhexidine tablets (diluted in water as needed).Or on an iodine felt-tip pen, but only the edges of the wound can be treated with iodine	Substance: Chlorhexidine (Chlorhexidine)
Septolet Antiseptic for sore throat 10 lozenges	Suck the lozenge on the tongue. Maximum 8 lozenges per day.	Ingredients: benzalkonium chloride, peppermint leaf oil, thymol, eucalyptus leaf oil, levomenthol (Benzalkonium chloride, Menthae piperitae oleum, Thymol, Eucalypti viminalis foliorum oleum, Levomentol)
Zyrtec Antihistamine: for allergies 10 tablets (10 mg)	1 tablet 10 mg once a day.Sometimes an initial dose of 5 mg is sufficient. Can be replaced with Loratidin.	Substance: Cetirizine Analog: Cetirizine

First aid kit for one adult on a quiet vacation for 2-3 weeks

Name and how much to take

How to Apply

Substance and cheap analogue

Nurofen
Pain reliever, antipyretic

20 tablets (200 mg)

1 tablet after meals 3-4 times a day.The dose can be increased to 400 mg 3 times a day.

Substance: Ibuprofen

Analog: Ibuprofen

No-shpa
For muscle spasms

6 tablets (40 mg)

1-2 tablets 2-3 times a day.

Substance: Drotaverine

Analog: Drotaverin

Polysorb MP
Sorbent: for food poisoning

10 sachets (3 g)

Mix 1 rounded tablespoon (2.5–3 g) with 100–150 ml of water.The powder is not taken orally dry, only in the form of an aqueous suspension.

Substance: Colloidal silicon dioxide

Analogue: Activated carbon (another group of sorbents)

Mezim forte
Digestive enzyme: for overeating, abdominal heaviness, bloating

10 tablets

1-2 tablets before meals with water. With meals, you can take another 1-4 tablets.

Substance: Pancreatin

Analogs: Pancreatin, Penzital

Cerucal
With vomiting, including interfering with medication

5 tablets (10 mg)

1 tablet 30 minutes before meals with water, 3-4 times a day.

Substance: Metoclopramide

Analog: Metoclopramide

Imodium
For diarrhea

6 tablets (2 mg)

Tablets are sucked on the tongue. The initial dose is 2 tablets (4 mg), then 1 tablet after each episode of diarrhea.

Substance: Loperamide

Analog: Loperamide

Chlorhexidine, plaster, bandage, cotton pads
Antiseptic for wound treatment

50 ml plastic bottle

Can be substituted for Chlorhexidine tablets (diluted in water as needed).Or on an iodine felt-tip pen, but only the edges of the wound can be treated with iodine

Substance: Chlorhexidine
(Chlorhexidine)

Septolet
Antiseptic for sore throat

10 lozenges

Suck the lozenge on the tongue. Maximum 8 lozenges per day.

Ingredients: benzalkonium chloride, peppermint leaf oil, thymol, eucalyptus leaf oil, levomenthol (Benzalkonium chloride, Menthae piperitae oleum, Thymol, Eucalypti viminalis foliorum oleum, Levomentol)

Zyrtec
Antihistamine: for allergies

10 tablets (10 mg)

1 tablet 10 mg once a day.Sometimes an initial dose of 5 mg is sufficient. Can be replaced with Loratidin.

Substance: Cetirizine

Analog: Cetirizine

We use Nurofen as a pain reliever. But if you are used to other pain relievers, add them to the list. Please note that “Analgin” and analogues (the active ingredient is sodium metamizole) are sold by prescription in many countries or are completely prohibited due to the risk of agranulocytosis. Analogs of “Ketorol” (ketorolac tromethamine), even if they can be bought just like that in Russia, it is better not to take them abroad without a prescription.

Some travelers carry broad-spectrum antibiotics in their travel medicine cabinet, such as amoxicillin. This makes sense if you cannot buy an antibiotic without a prescription in the required country and you do not want to go to a local doctor, but prefer to consult your doctor in Russia by phone.

If you are going to the sea, add a sunburn remedy such as Bepanten or Panthenol to the basic list of medicines.

What to add to the first aid kit at sea

Name

Method of application, substance and cheap analogue

Bepanten sunburn cream

Take a cool shower or compress, for example with a towel, to cool the skin before applying.

Substance: Dexpanthenol
Analog: Dexpanthenol ointment

If you are planning to get out into nature and spend time actively, add repellent, elastic bandage and insect bite allergy medicine to your first aid kit.

If you are going to places where tick-borne encephalitis is widespread (the link will open the data for 2020 for the subjects of the Russian Federation), then think in advance about taking a course of preventive vaccinations, and also take a tick repellent on your trip.

For detailed recommendations on how to avoid a tick bite and what to do if the tick does bite, read on the Rospotrebnadzor website.

What to add to a first aid kit for outdoor activities
Name	Method of application, substance and cheap analogue
Gardex Family aerosol Mosquito repellent	In places where tick-borne encephalitis is widespread (including Siberia, the Urals, the Far East), also take a tick repellent, for example, Mosquitall “Protection against ticks”.It is applied to clothing and not to the body. Substance: DEET Analog: DEET
Psilo-balm Anti-allergic insect bites	Apply a thin layer to the affected area 3-4 times a day. Also helps with sunburn. Substance: Diphenhydramine hydrochloride
Elastic bandage	In case of sprains or dislocations.Instructions on how to bandage.

This is the minimum set for outdoor activities close to civilization. In addition to this list, take your medicines that you drink regularly (making sure they can be transported across the border).

Medical masks, gloves, wet wipes and hand sanitizer in 2020-2021 have become commonplace even for a trip to the nearest store, so you will hardly forget them.

First aid kit on the road: how to transport medicines across the border

Each country has its own rules for the import of medical products.Narcotic, psychotropic and potent substances are under special control everywhere, but their lists differ.

Medicines readily available in our country can be sold abroad only by prescription, considered narcotic or psychotropic, or even prohibited. For example, in the United States, “Corvalol” is banned, which until 2010 was in every Russian automobile first aid kit. But in America, methylphenidate is prescribed for the treatment of attention deficit hyperactivity disorder, which is illegal in Russia.

The good news is that basic drugs are generally not questioned by customs. Although if the drug is prescription (and not in Russia, but where you are going, and this should be checked in advance), they may ask for a prescription or a certificate from a doctor. Look for the rules of the countries on the websites of customs services, but the surest way to find out how things really are is to ask a question at the consulate of the desired country.

If the drug is prescription, but is not included in the list of especially controlled ones, then the prescription can be in Russian – the main thing is that it is correctly filled out.The prescription form must be signed by the doctor and the seal of the medical institution, as well as the active ingredient in Latin (not a trade name!), The dosage and duration of admission. For example:

Rp .: Tab. Clarithromycini 0.5 N 14

D.S. Take orally 1 tablet 3 times a day with a glass of water.

You can ask the doctor to write in English your name and comment about the medication:

D.S. 1 tablet 3 times per day with glass of water.

If you are taking a drug from the list of strong or narcotic and psychotropic substances, check if it is allowed in the country of destination and what are the conditions for import. There are almost always restrictions on the quantity: you can import the medicine for no more than 1-3 months of administration. You may need a prescription written in English or a local language or a notarized translation to clear customs.

When departing from Russia and upon arrival in another country, honestly declare everything and choose the red corridor instead of the green one.

How to buy medicine abroad according to the Russian prescription

Foreign pharmacies often accept prescriptions in Russian with the name of the substance in Latin. But according to the rules, if a doctor is certified in Russia, then his prescription is invalid abroad. Therefore, in strict countries, you will have to look at a doctor who will write out a new paper.

The local doctor may issue his prescription based on yours, but not always. It happens that an examination or medical documentation is required, translated into English and certified by a notary, especially when it comes to drugs from the controlled list.

How to find an analogue of your medicine abroad

Symptomatic drugs, for example, for colds and flu, mild pain relievers, antipyretics – sold without a prescription even in Europe.

You can also buy more specific non-prescription drugs even if you don’t understand a word in the local language. To do this, you need to know the international name of the drug.

Since 1953, the World Health Organization has been working to ensure that all active substances (that is, the active ingredients of medicines) receive International Nonproprietary Names – unique names that are understood throughout the world.

INN lists are updated every year. Now there are more than 8000 of them, and for each name in Latin there are equivalents in Russian, English, French, Spanish, Chinese and Arabic.

How to use the international drug list and find the right remedy in any country

Let’s use an example to show you how to use the generic drug list abroad. Let’s say you need Nurofen. If the instruction has been preserved, take a look at it: at the very beginning, in addition to the trade name “Nurofen”, the international non-proprietary name – ibuprofen – is immediately indicated.If there is no instruction, it can be found on the Internet – this is the easiest way.

A more complicated option: go to the website of the State Register of Medicines of the Ministry of Health, enter “Nurofen” in the line “trade name” and click “Find”. See the International Non-Proprietary Name column for the active ingredient.

So, you found out that the active ingredient in Nurofen is ibuprofen. Go to any pharmacy abroad and just tell the pharmacist that you need ibuprofen to get started.If you are not understood, translate the name into the desired language (with the help of a translator on your phone or write it down in advance at home on a piece of paper, finding the translation, for example, in the English-language Wikipedia) and show it at the pharmacy. In most cases, this works.

Please note that many medicines, including antibiotics, require a prescription to purchase: either from your Russian doctor indicating the active ingredient in Latin, or from a local doctor.

“Once in China, I explained myself to pharmacists practically without words.I needed to replenish the Diakarba supply. This medicine is used at altitude to treat altitude sickness. I was in a small town, practically in a village, where no one understood English, let alone Russian. The active ingredient “Diacarba” is acetazolamide. I wrote it in Latin – acetazolamide – on a piece of paper and showed it at the pharmacy, but they did not understand me.
There were two volumes of some sort behind the counter. It turned out – Chinese reference books of medicines. In one of them I found an index on the Latin names of drugs.On the right page were written all the brands of acetazolamide produced in China – in hieroglyphs, of course. When the pharmacist brought the pack, I found the Latin name in the instructions, which completely eliminated the mistake when buying. ”
Pavel Borisov, travel blogger

Checklist: how to properly assemble a travel first aid kit

Put all your “own” medications that you take regularly in your medicine cabinet.
Take only those drugs that you know how to use and for which you definitely have no contraindications.
Take the instruction. When it comes to a first aid kit, you can easily get nervous and forget about dosages and compatibility with other drugs. The full version of the instructions can be stored in a smartphone, and put a list of medicines with short explanations and a scheme of administration in the first-aid kit. To prevent an important sheet from tearing and rubbing, laminate it or simply tape it on both sides with tape
Check the expiration dates. Make sure your medicines are not expired, especially if you take them from your home medicine cabinet, which sometimes gathers dust for years.
Read the storage conditions. Take a look at the instructions and make sure that the medicines will not spoil on the trip. For example, candles melt at temperatures above +25 ° C, while others need to be kept cold. You may need a cooler bag – don’t be alarmed, they come in the size of a cosmetic bag.
If possible, replace liquid preparations with tablets and powders. Tablets, powders and capsules weigh less liquids in their original packaging and will not fill the entire suitcase.If the medicine needs to be taken in liquid form (the same chlorhexidine), try to buy it not in a glass, but in a plastic bottle so that it does not break for sure.
On the plane, take liquid medicines in containers larger than 100 ml in baggage or carry them in carry-on baggage with a doctor’s certificate stating that they are vital
Make sure that the opened package has the name and expiration date. A started blister of tablets, on which the name of the medicine is not visible, is best replaced with a whole one.So you will avoid unnecessary questions at the border and will not forget what kind of drug you took with you.
Be careful about saving weight. Throwing out the bulky cardboard boxes is a good idea. But, if you are flying abroad, all medicines should be easily identifiable so that the customs officer does not have to guess what you are carrying. At least the name of the drug should be read on the blister, but if you have even the slightest suspicion of interest from the customs, it is better to leave the drugs in their original packaging.
Take a reasonable supply of prescription drugs. In other countries, drugs are most often allowed to be imported for 3 months of admission. Even if you are not going for so long, take essential medications (for example, insulin) with a reserve: suddenly the flight will be postponed or you will have to be delayed on a business trip.
Don’t forget the recipe. Attach a correctly drawn up prescription or a doctor’s certificate to your prescription drugs – show them to customs if you have any questions.

First aid kit on the road: answers to the main questions

What medications do you need to take with you on vacation?

If you are traveling to a developed country and do not plan to move too far from civilization, then, according to WHO recommendations, you should take only the most necessary medicines. They will come in handy so as not to run to the pharmacy because of every cut and to be able to provide simple emergency assistance to yourself and your loved ones. Also put in the medicine cabinet the usual medicines that you drink regularly.If something more serious happened on vacation or you feel unwell, do not heal yourself – see a doctor.

What are the basic rules to follow when collecting a first aid kit for the trip?

The main thing is that you must be able to use all the medicines from the first-aid kit. Take only proven products and just in case, print and take a short list of all drugs with dosages: in an emergency, you can forget something like that.

Can medicines be transported across the border?

Conventional medicines can be transported across state borders without problems, you just need to make sure in advance that in all countries along your route the active substance is not included in the list of prohibited or especially controlled ones.Medicines containing psychotropic, narcotic or potent substances must be transported across the border with a prescription from a doctor or an extract from a medical history – and must be declared.

How to carry medicines correctly in carry-on baggage?

It is allowed to take medicines in solid form in hand luggage: tablets, granules, dragees, powders. Ointments, creams, potions, infusions, emulsions and other medicines in liquid and soft form can be taken to the salon only in containers up to 100 ml, packed in one transparent bag measuring 20 × 20 cm.An exception is made for medicines that are vital for the duration of the flight, but it is better to have a doctor’s note with you.

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