I want to talk about the positive preventive effect of the group of medicine to the mountain sickness.
The effective preventive remedy for acute mountain sickness is acetazolamide (synonyms diacarb, dilamox, anicar, acetamox). The researches show the protective effect which doesn't influence an urination if you take 50-125 mg every 8 hours. You have to start to take pills a day before or at the very beginning of climbing and to stop in 2 days after reaching the needed height. Acetazolamide is also available in the form of capsules of 500 mg of long-acting (taken once a day). The abrupt discontinuation of the drug can lead to the development of high-altitude pulmonary edema and high-altitude cerebral edema, that’s why you’d have the sufficient supply of the drug and take it during the hunting trip, or you should refuse to use it at all. It’s very important to monitor the occurrence of possible side effects such as allergy, tingling in the fingers, changes in taste, excessive urination, nausea, digestive disorders, and if they occur, you should reduce or stop taking the drug.
Taking of aspirin, paracetamol, ibuprofen could reduce the headache and decrease the risk of pulmonary edema.
I’ve heard that the European hunters use as preventive medicine prochlorperazine (etaperazine) 4-10 mg orally every 6 hours, but not the hunters from the Ocean. Antacids (sodium bicarbonate, rennie, almagel, phosphalugel, etc.) are useless. They say about the positive influence of ascorbic acid (vitamin C) in a dose higher than 2 g per dose several times a day, but it's not proved. Dexamethasone, if you take it 4 mg orally every 6 hours, dramatically reduces the severity of acute mountain sickness but it has some adverse effects and the doctors don’t advise to use it as the preventive remedy but for treatment only. Pentoxifylline (trental) is used in some countries as a drug that improves brain function in high-altitude conditions. The locals in South America traditionally use coca leaves for the prevention and treatment of altitude sickness, but iit is not possible to recommend them for use in our situation.
We can recommend hypoxene from the modern domestic drugs. This antihypoxic agent has an antioxidant, metabolic, vasodilating and hypotensive effect. The drug increases the effectiveness of tissue respiration in hypoxic conditions, especially in organs with a high level of metabolism (brain, heart muscle, liver). It helps to reduce oxygen consumption during significant physical exertion, improves tissue respiration, reduces the degree of mental and physical fatigue, and facilitates the performance of time-consuming physical operations. This remedy optimize the activity of the mitochondria of cells, reduces oxygen consumption. It has antiradical and antioxidant effects. It is available in capsules of 250 mg. You should 2-4 capsules per reception, but no more than 12 capsules per day.
Mildronate is a metabolic agent that balances the delivery and demand of cells for oxygen, eliminates the accumulation of toxic metabolic products. It helps to restore energy resources and improve motivation (intake – 1 g per day in the morning).
When I was going to write this article, I didn’t plan to include the theme, written below. It’s devoted to the treatment of mountains sickness and is for the specialists use only or for people who has to provide assistance in the natural environment. But later I’ve decides to present these materials.
Mountains, as any remote area, are known by unpredictable situations which can happen there and the hunter has only himself and people who are near him. So, you should have the right algorithm what to do if goes wrong. Once my friend, the very experienced guy, met a group of tourists, almost kids, in the mountains and saved one of them because they didn’t know what to do. You can’t hope that the chopper will arrive fast or the ATV with doctors can find you, or the local doctor will go somewhere and meet your group, there are so many things which can prevent from weather, the absence of roads, and thousand reasons. We won’t discuss it here.
The treatment of acute pulmonary edema includes the usage of a sufficient amount of fluid, taking painkillers, a light diet, limiting physical activity and, in rare cases, descending from a height. Acetazolamide is prescribed (if it has not been taken before) 250 mg orally every 4 hours, in cases of acute mountain sickness and high-altitude pulmonary edema. If the patient felt worse the bed rest is required and inhaling oxygen (if there is one). The immediate taking of nifedipine is recommended: initially 10 mg, then 20-30 mg (preferably slow-release capsules) every 12 hours until the symptoms disappear. If it doesn’t help the patient has to be immediately evacuated down. The goal is to move to the height lower than the last one where he felt well when has woke in the morning. Sometimes it's enough to descend on 500-900 m. You should think over the evacuation route and how to do it beforehand when planning the trip or ask about it the host party.
Dexamethasone is prescribed 8 mg by injection intramuscularly or intravenously, then 4-8 mg every 4-6 hours, in cases of acute high-altitude brain edema though the effect can be moderate. If you or somebody from your group have symptoms of the mountain sickness, you should inform the outfitter, the trusted persons at home and, if necessary, local and international rescue and medical services – they can also get medical advice by means of communication. it is necessary to take care of the means of communication in advance (the best option is a satellite phone with a set of spare power) and have phone numbers (preferably several) of local and international rescue and medical services (choose services where several languages of communication are available). I hope you realize how important it is to have extended insurance coverage.
In conclusion, I’ll repeat the main recommendations to avoid the mountain sickness because the prevention is the most effective part of the modern medicine.
It’s better to spend first two nights on the heigh not higher than 2400m.
Don’t climb than 400-600m per day.
When rising during the day, always go down a little before going to bed.
Sleep, water and food intake should be sufficient.
You should avoid overwork and excessive physical exertion.
I advise you not to smoke and take sedatives and alcohol while hunting.
I offer to apply acetazolamide 250 mg per day from the first day of your stay in the mountains.
If you follow these simple rules, the altitude sickness never spoil your impressions and plans.
Sergey Rudnev, expert on certification of the ACC of the Ministry of Emergency Situations of Russia
