Climbers' nightmare

If left untreated, acute mountain sickness can lead to fluid accumulation in the brain and lungs, writes Olivia Miwil.

Ruby suffered nausea, stomach discomfort and headaches while climbing Mount Kinabalu late last year, after the reopening of the trail, but never thought that she could have been suffering from acute mountain sickness (AMS).

She managed to reach the peak of Mount Kinabalu but had to be carried down by Fire and Rescue personnel. It was her third climb of the mountain and she had never experienced the illness before.

“I am aware of the signs and symptoms of acute mountain sickness but never though it could happen to me. When I got sick, I thought it was an allergic reaction so I did not say anything to anybody,” she says. She had trouble sleeping and had been feeling restless since the first day.

Besides medication, she was also given intravenous fluids upon reaching the starting point. Ruby was advised to get admitted to the hospital for monitoring but instead, rested at home. It took her about a week to recover.

In November 2013, a group of General Task Force personnel who were undergoing special operations training were stranded on the mountain for three days after one succumbed to the same illness.  

Lahad Datu Hospital medical officer Dr Muhammad Naim Razak, who was treating climbers during the inaugural trip following the reopening of the mountain, said one’s fitness level was not the determining factor for being struck down by the sickness.

“Some people develop the sickness when they climb more than 2,000m (above sea level) within a day as the oxygen concentration and the moisture level drop at higher place.

Among the noticeable symptoms for the sickness are headaches, particularly on the front or both sides of the head, gastrointestinal discomfort or loss of appetite, as well as sleeping problems.

The sickness can progress to more severe conditions causing edema or accumulation of fluid in the brain or the lungs, or both.

For the lungs, the condition is known as High Altitude Pulmonary Edema, with symptoms such as a fast heart and respiratory rate, coughing, and the skin turning blue. The climber's oxygen saturation level will also be assessed using portable pulse oximetry.

Meanwhile, in High Altitude Cerebral Edema (HACE), the brain function is affected by pressure changes.

TAKE IT SLOW

Climbers will show drowsiness, an altered mental state or even behavioural changes. Dr Naim advises those having mild sickness to climb slowly.

"They have to stay at a lower altitude for a longer time before ascending to allow the body to adjust to the changes. Under doctor's advice, they can get medicines such as an acetazolamide tablet or steroid injection into the muscle, which will help in reducing fluid build-up.

"For those with a serious condition, both medications will be administered," he said, adding painkillers, oxygen and rehydration can expedite the recovery process.

A Gamaw bag, an inflatable pressure bag which is large enough to accommodate a person inside, is used to treat a climber in a critical condition.

He adds that medical personnel usually use the Lake Louise scoring system to determine the course of treatment to be given. The system uses an assessment questionnaire and a scorecard to decide the severity of the sickness. Content of the self-assessment questionnaire include the presence of headache, fatigue and weakness, dizziness and light-headedness, and difficulty sleeping.