Complications of AMS

There are various complications that can arise if one chooses to ignore the symptoms of AMS, thereby allowing it to progress further. Absolutely no chance must be taken after the first signs of AMS are noticed, else the condition of the patient will drastically deteriorate and this can lead to his/her death.

HACE (High Altitude Cerebral Edema)

HACE is the accumulation of fluid in and around the brain. It can solely crop up on its own or as a complication of untreated AMS. Following are some of the symptoms of HACE:

• Vomiting
• Exhaustion
• Fatigue
• Hallucinations
• Walking with a stagger
• Clumsiness
• Confusion
• Declining level of consciousness

When HACE strikes

The first prevention strategy you can apply for any altitude sickness is to carry lifesaving medication. Life Saving Drugs (like Dexamethasone and Diamox) should mandatorily be carried by every trekker doing high altitude treks, regardless of whether they are ever going to use them. A trekker might never need to use them for a very long period of time during treks but it is uncertainty that matters here and we would like to eliminate this risk by carrying medication before calamity strikes.

What are the steps one needs to take when they are suspected of having HACE?
As per popular medical literature website NCBI ( https://www.ncbi.nlm.nih.gov/ ), the following steps need to be taken:

1. Take 4mg of Dexamethasone.
2. Start descending immediately and aim to get to below 8000ft.
3. In case you are already at a very high altitude, where it could take a day or two to get to 8000ft, the following steps can be followed: Take 1 tablet of Diamox along with 4mg of Dexamethasone and keep taking Dex every six hours till you reach 8000 ft.
4. Gradually reduce the dosage of Dex once you have reached 8000ft and taper off tablet-wise as it is a steroid and cannot be stopped abruptly.
5. Once you reach 8000ft, take Diamox along with Dex following the same 6 hour schedule.

HAPE (High Altitude Pulmonary Edema)

HAPE is the accumulation of fluid in the lungs. In this condition, the lungs are unable to exchange oxygen and carbon dioxide properly and the patient cannot get enough oxygen to function properly. HAPE generally strikes mountaineers at altitudes exceeding 14000 ft. Following are some of the symptoms of HAPE:

• Chest tightness
• Confusion
• Collapsing
• Breathlessness
• A rapid heart rate
• Reduced physical performance and breathing
• Weakness
• Shallow breathing

When HAPE strikes
As per Medical News Today (www.medicalnewstoday.com), one can take the following steps:

1. As it is with HACE, the individual needs to start descending immediately, preferably by at least 2000ft.
2. Make the patient rest and provide supplemental oxygen. If diagnosed early, the patient recovers quickly on a mere 500–1000 metres descent.
3. Acetazolamide or Nifidipine can be taken immediately when HAPE strikes.
4. Sildenafil can also be used to relieve symptoms of AMS, HAPE and HACE.

Hypothermia, dehydration and low blood sugar share similar symptoms with altitude illness. Therefore, it is all the more important to get the patient to a physician as soon as possible if any of the symptoms persist.

HAPE and HACE are relatively rare as compared to AMS but can occur if a person ascends to a high altitude rapidly and stays there for a long time.

References:

1. https://www.medicalnewstoday.com/articles/179819.php
2. https://www.ncbi.nlm.nih.gov/pubmed/21962063