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Altitude Illness

1. Is altitude illness probable in this case? Why? Is it odd that the two patients are so different in fitness and age?
   
2. What treatments would you prescribe for these patients? Is it safe for them to continue their stay?
   
3. How could they have properly prepared for and prevented this illness?
   
   ANSWERS:
   
   
   1. Altitude illness most often occurs at altitudes in excess of 2000 meters. The patients' symptoms are characteristic of altitude illness. Any combination of these symptoms as well as dizziness, fatigue, and insomnia indicate Acute Mountain Sickness (AMS), but since there is no definitive test an accurate history is most important. Their rapid ascent makes AMS a very probable cause. AMS seems to be equally probable regardless of fitness level, gender, or age
      
      
   2. In all cases of altitude illness, descent is the definitive treatment. With mild cases of AMS, however rest at the current altitude is often sufficient. Acetazolamide and dexamethasone are effective treatments, but patients should wait 18 hours after using any steroid before further ascent. If symptoms do not recur, the patients should be fine to continue their trip. They should be on the lookout, however for respiratory or neurological symptoms that may indicate more serious conditions.
      
      
   3. Starting acetazolamide 1-2 days before ascent is effective for AMS prophylaxis, however gradual ascent is the safest method for acclimatization. Patients without experience at altitude should spend two or three nights at 2500-3000 meters before further ascent. Increases of more than 600 m should be avoided and an extra night for every gain of 300-900 m is highly recommended.
      

 Because AMS symptoms resemble many other common conditions such as food poisoning or flu, it can be a difficult condition to diagnose. Remember that an accurate history is your best diagnostic tool. Let your patients know that AMS can progress very quickly into life-threatening conditions and should be properly treated before ascent. The key to prevention is gradual increase of sleeping altitude and the most definitive treatment is descent. Be safe at high altitudes!