Altitude sickness in youth groups.

Abstract

Acetazolamide (AZ) is used by mountaineers to prevent and treat acute mountain sickness (AMS). Minor side effects are common and can be unpleasant (tingling fingers, altered taste), although serious side effects are rare (Stevens Johnson syndrome, allergy). AMS can usually be avoided by choosing a slow ascent profile giving the body time to acclimate naturally.1.Hackett P.H. Roach R.C. Current concepts. High altitude illness.NEJM. 2001; 345: 107-114Crossref PubMed Scopus (1023) Google Scholar Teenagers are being taken in increasing numbers to high altitude destinations on organized tours. For example, World Challenge expeditions took 2640 teenagers on expeditions in the year 2000, many to high altitude. Little morbidity was reported, proving that these groups can be taken safely to remote parts of the world.2.Dallimore J. Cooke F.J. Forbes K. Morbidity on youth expeditions to developing countries.Wilderness Environ Med. 2002; 13: 1-4Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Safety is facilitated by World Challenge employing a professional medical advisor, and by ascent strategies that avoid mountain sickness. However, medical input can be a two-edged sword. Some tour operators taking groups prescribe prophylactic acetazolamide to all the members of their treks when ascending above a particular altitude—“as company policy.” This practise is justified in the erroneous belief that “AZ aids acclimation” and that “AMS, high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE) are part of the same disease spectrum.” This leads to the assumption that AZ should reduce the incidence of these conditions, and increase safety. However:1)It is not universally agreed that AZ aids acclimation. It is agreed that it improves oxygenation.2)It is not universally agreed that AMS, HAPE, and HACE are part of the same disease spectrum, especially with reference to HAPE There is little information on the safety of AZ prophylaxis in children. The guidelines drawn up by the International Society for Mountain Medicine suggest acclimating slowly and naturally only using AZ if an individual is known to be susceptible to mountain sickness, or if using a necessarily fast ascent profile. These companies claim to be using “safe” ascent profiles. If this is so, then there should be no benefit from the standard use of AZ and exposing all members to unnecessary side effects. The routine use of AZ may tempt groups to ascend more rapidly than the current guidelines. Medical opinion is divided on the safest way for groups of young people to enjoy altitude holidays and I believe that there should be further open discussion on this issue.