Acclimatization To The Altitude And Mountain Pathologies-3rd Part

In this third part of our series of articles on Acclimatization to the altitude and mountain pathologies we treat the pathologies arising from problems of acclimatization to the altitude and that relate directly to the exposure of the body to hypoxic States. (read the first part and the second part)
An important signal to be observed, at the beginning of the period of exposure to altitude, is whether or not the production of a marked diuresis, or increasing the amount of urine. The phenomenon of diuresis, in the early days of acclimatization, is a result of changes in the balance of fluids in the body is still not fully understood by medicine.
A antidiurese is a sign of poor acclimatization, and may lead to the emergence of the MAM (evil acute mountain), since the reduction in urine indicates a fluid retention in the body. Such fluid retention can lead to peripheral edema, pulmonary edema or cerebral edema. That’s why, on the Score of Lake Louis, used for determining the severity of the MAM (as we’ve seen earlier), the reduction in the volume of urine receive the maximum score (3 points), because it is an important signal of poor acclimatization which should be seriously taken into consideration.
People, when they get to altitude, complain of constant need to go to the bathroom, often overnight, and some start to avoid ingesting liquids to try and lessen the urge to urinate. However, decrease fluid intake will not break the diuresis, if the body is properly acclimating (go to the bathroom constantly should be cause for joy and not pain), potentially leading to a State of dehydration that may harm the acclimatization and thus worsen the trend to MAM.
Some of the symptoms of MAM, like nausea, dizziness and weakness, may be associated with dehydration. Stop drinking liquid, dehydrate and interrupt the diuresis also prevents the observation of this important good acclimatization. In people well hydrated, the phenomenon of antidiurese becomes clearer, because if they have a reduced urine volume won’t be from dehydration, but due to the antidiurese that leads to the MAM and the signal, in the early stages of exposure to altitude, allows one to identify in advance the trend to reach the MAM, avoiding evolve into a framework of moderate or severe MAM and enabling the adoption of a more appropriate strategy of acclimatization.
People diagnosed with antidiurese should not be medicated with Diuretics are also dehydrated. Among the clinical signs of dehydration are the throat, the tongue and the skin dry. Observe the heartbeats per minute can also help, because a pulse in an upright position with values around 20% larger than lying can be a sign of dehydration. If it is necessary to treat antidiurese with a diuretic medication, should be administered along with fluids.
The acetazolamide (Diamox or) is not the medicine man in this context, because their effects are not as potent diuretics, as discussed previously. It never hurts to emphasize that one should avoid self-medication, and it is wise to get a medical recommendation for that.The Aconcagua Provincial Park is provided with medical services in the camps, which facilitates the treatment of symptoms of MAM in a manner oriented and appropriate for people who are climbing this mountain.
As described in the first article of the series, the evil acute mountain (MAM) corresponds to a large set of symptoms and signs, which can vary widely from person to person, being the major manifestations are headaches, nausea, lack of appetite and sleeplessness and can appear vomiting, fatigue, nausea, dizziness, tiredness at home, among others.
It’s a syndrome of difficult forecast and whose propensity cannot be determined for any exam. There are no significant differences in occurrence of symptoms between sexes, but there seems to be a greater susceptibility among younger people.
Despite the conditions of hypoxia, or low oxygen pressures, being the obvious origin of MAM, there are two main theories about what would be the mechanism that produces the perceived symptoms. The first is that the appearance of the symptoms is a result of the formation of premature cerebral edema due to imbalance in body fluids in the initial period of exposure to altitude.
I’ve another theory relates the symptoms with the chemical changes that occur in the blood, in function of the respiratory alkalosis generated by hyperventilation, detailed in the first article. Before presenting the pathologies themselves, we will briefly describe the main symptoms of MAM.
Headache
Headache is the most common symptom, being described by the consensus of Lake Louis as the basic symptom that defines the appearance of MAM. It is important to note the severity of the pain, since it is an important clue. A mild pain that goes away with rest or only with aspirin is not always associated with the MAM. Ever the pain that develops overnight and continues to arouse, possibly, is an indication of MAM.
On the other hand, a headache that goes from moderate to severe and persisting with aspirin and home is a sign that you need to stop rising or it is necessary to descend, when it lingers after the second day at the same altitude.
The most likely causes of headache are the formation of premature cerebral edema and the dilation or constriction of the arteries of the head.
Insomnia
Insomnia is manifested as a difficulty sleeping or waking up often during the night, being more common in first week of stay in altitude, improving in the second week. Avoid taking medicine barbiturates andopiláceos, since the same causes a respiratory depression.
A respiratory disorder that can bring some difficulty sleeping is called periodic breathing, which leads the person to wake up during the night with a feeling of breathlessness or choking.
It’s not a serious problem, if not accompanied by other symptoms of MAM, occurring, usually when, after a string of four breaths, there is an interruption of breath for 10 or 15 seconds.
The longer the period of non-breathing (apnea), the greater the probability that the person wakes up. Usually improves with the use ofacetazolamide (Diamox).
Gastrointestinal symptoms
Loss of appetite (anorexia) is a subjective symptom and is only associated with the MAM when combined with headache, insomnia or other symptoms.
Nausea is the most common symptom and accompanies the MAM soft. Already the vomiting is more serious, but if there is no headache or other symptoms of MAM, one should consider other causes.
For example, if there is diarrhea or fever, may be a gastroenteritis or dysentery. The vomiting can cause dehydration, as well as lead to loss of electrolyte salts, especially potassium, and must go down to a recovery.
Medications for vomiting should be administered preferably rectally or injectable.
Lung symptoms
The most obvious symptom of possible lung problems cough, which may be dry or wet. The cold, dry air of the mountain environment can be irritating to respiratory system and cause a deep and dry cough, for which adequate hydration is recommended and throat lozenges.
Only by observing if the cough is dry or damp it is not possible to know if the same is caused by the dry air or pulmonary edema, because only in advanced stages Lung edema presents wet cough with rosacea coloring or oxidized, being in the initial periods. If the cough is caused by the conditions of the environment itself, will not affect the strength of the climber.
If you feel weak, the cough can be caused by pulmonary edema.Pulmonary edema causes a feeling of saturation in the chest, with frequent cough associated with the lack of severe breathing during physical exertion or lack of breathing moderate during the rest.
Another sign that may indicate if the cough is caused by an edema is the presence of pain. Chest pain is not common in pulmonary edema, but usually presents itself in chest infections, such as pneumonia or Pleurisy, or for a broken rib or cartilege.
Fatigue
This is a major symptom that should be carefully watched, as it may be an indication of serious problems, such as a cerebral edema.Fatigue can be described as an extreme tiredness or exhaustion, which leads to the Mountaineer to a certain indifference and not wanting to get up or out of tent to eat, or go to the bathroom.
But, unlike the physical exhaustion, which works with a night’s rest, hydration and nutrition, this state of fatigue cannot be solved with the rest and 24 or 48 hours evolves into being often the only symptom.
When the State of the person does not allow you to even get up, the action should be immediate, because there may be loss of consciousness from 12 to 24 hours. If there is a severe fatigue or associated with loss of motor coordination (ataxia), is due to step down as soon as possible, because it can be the sign of a brain edema.
A key to differentiate of MAM is hypothermia, since these symptoms also appear in hypothermic States.
Ataxia (loss of coordination)
Ataxia, loss of motor coordination is another important symptom that can be associated with serious complications such as cerebral edema, because the cerebellum, which is the part of the brain that controls the coordination of various muscle groups, the balance and spatial orientation, need a job fast and is very sensitive to hypoxia, being quite affected in the case of a cerebral edema.
Ataxia does not indicate necessarily cerebral edema, as is also seen in cases of hypothermia. However, due to the severity of their evidence, the question should be treated as cerebral edema.
If you don’t observe other symptoms of MAM, can be a hypothermia or exhaustion and may be safer to remain in the same altitude, treating these conditions. If ataxia remains after rest and to warm up, must come down.
Once the ataxia, the patient may deteriorate in 6 or 12 hours.
Reduced urine volume
As previously, the lack of diuresis or a low volume of urine is an abnormal situation in altitude and is a serious clue about the occurrence of MAM.
In this context, mild symptoms should be taken with more severity in the presence of urine.
Peripheral edema
Peripheral edema is a Swelling around the eyes and the face, hands, ankles or feet produced by a distribution or abnormal retention of fluids, there is no pain associated. It is more common in the hands, but not always related to the MAM in these cases because it can be triggered during a walk through the use of watches, gloves or rings.
A swelling in the eye area and face usually is associated with the MAM, being the fluid seems to accumulate during the night. Already the possibility of women having greater provision for peripheral edema before menstruation is an unproven assumption.
Facial edema is not a gauge to descend, just close your eyes affect vision. The treatment in this case is done with diuretic, resting in lower altitudes. Diuresis normally starts after the descent, which may take 1 or 2 days.
Edema of the leg can be treated lying down and rising up the leg above the heart. If you are pressing the boot, there is a risk of freezing, recommended use of diuretics. All people with peripheral edema should be evaluated to verify that they do not present pulmonary edema or cerebral.
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