Mountain disease

Description:

Mountain disease — the morbid condition developing owing to the low partial pressure of atmospheric gases, mainly oxygen in the conditions of highlands. Distinguish acute, subacute and chronic forms of a mountain disease. The first two forms at the heights from 2500 to 4000 m are registered at 10 — 20%, and it is higher than 4500 m — practically at all ascending to mountains. The chronic mountain disease develops at natives of mountains (at heights usually more than 3000 m) and meets much less often.
Low partial pressure of oxygen in the atmosphere breaks gas exchange, causes a hypoxia of fabrics that leads to dysfunction of bodies, including a brain, to increase in permeability of vascular membranes, changes of water and electrolytic balance With a delay in a liquid organism.

Symptoms of the Mountain disease:

Clinical picture of acute and subacute forms of a mountain disease generally similar, but at an acute form symptoms of a disease accrue promptly (the patient acute management can be necessary), and at subacute — gradually and remain rather long (more than 7 — 10 days). Headaches, nausea, sometimes vomiting, fatigue, an asthma, heartbeat, a meteorism are noted. Patients are apathetic (are sometimes excited), sleep badly (a dream discontinuous, uneasy). Diffusion cyanosis, increase in frequency and depth of breath, increase of pulse, decrease in the ABP are observed. On the ball 5000 m can be a loss of consciousness. On an ECG — right axis deviation, a smoothness or inversion of a tooth of T. V of blood are defined a hyperglobulia, a hypergemoglobinemia, decrease in reserve alkalinity.

As independent forms of mountain pathology allocate a mountain acute fluid lungs and mountain acute wet brain. The first arises in 1 — 4 days after bystry rise on height more than 2700 m and is shown by a headache and the accruing short wind as a tachypnea ("breath of the tired-out dog") accompanied with a tussiculation, then emergence of a bloody foamy phlegm, the bubbling breath in the beginning. At survey come to light cyanosis of lips, tachycardia, in lungs — wet small - and srednepuzyrchaty rattles is noted. In several hours the coma can develop. Body temperature normal or subfebrile; in blood — a moderate leukocytosis, small increase in SOE. Mountain acute wet brain is shown by the accruing headache, gait disturbance, stupefaction and hallucinations, nausea, vomiting, an oliguria, an asthma and heartbeat, depression, then the block which is replaced by a coma.

The chronic mountain disease develops gradually and is shown by working capacity reduction, an asthma, cough (sometimes a pneumorrhagia), dizziness, faints. The face of patients gets cherry and cyanochroic coloring. Often "drum fingers" come to light. Pulse is speeded up, borders of heart are expanded to the right. In blood test the polycythemia comes to light. The most frequent complications are congestive heart failure, disturbances of a cordial rhythm, a thromboembolism.

Reasons of the Mountain disease:

Height at which the mountain disease develops varies owing to influence of numerous factors, both individual, and climatic.

Development of a mountain disease is influenced by the following individual factors:

    * individual resistance of people to a lack of oxygen (for example, at inhabitants of mountains);
    * a floor (women have a hypoxia better);
    * age (young people badly have a hypoxia);
    * physical, mental and morale;
    * fitness level;
    * speed of ascent;
    * degree and duration of air hunger;
    * intensity of muscular efforts;
    * last "high-rise" experience.

The following factors provoke development of a mountain disease and reduce portability of big heights:

    * availability of alcohol or caffeine in blood;
    * sleeplessness, overfatigue;
    * psychoemotional tension;
    * overcooling;
    * low-quality and irrational food;
    * disturbance of the water-salt mode, dehydration;
    * excess body weight;
    * respiratory and other chronic diseases (for example quinsy, bronchitis, pneumonia, chronic purulent dental diseases);
    * blood losses.

Treatment of the Mountain disease:

Treatment at an acute mountain disease of easy degree, as a rule, is not required; at a mountain disease of heavy degree treatment is begun on site with immediate oxygen therapy, and at mountain acute wet brain or lungs also with intravenous administration of small doses of high-speed diuretics (furosemide on 2 mg) and reception of Diacarbum inside (on 250 mg each 4 h), the antagonists of calcium reducing pressure in pulmonary arteries apply (nifedipine), at wet brain — glucocorticoids (dexamethasone); if necessary suck away a secret from a trachea and bronchial tubes; patients are urgently evacuated to areas, the located lower than 2000 m. At a moderately severe mountain disease limit the volume of the accepted liquid, table salt and the use of the products promoting a meteorism. The respiratory gymnastics (with moderate increase in resistance to an exhalation), if necessary — oxygen inhalation is recommended. If symptoms of a mountain disease do not regress in the next 3 days, further stay in mountains is contraindicated. At a chronic mountain disease with pulmonary hypertensia antagonists of calcium apply, and at congestive insufficiency — diuretics.

Prevention of an acute mountain disease consists in medical selection of the persons sent to mountains, their preliminary physical training, a special training in hypobaric pressures chamber. Gradual (step) ascension to mountains and restriction of exercise stresses is recommended that improves mountain adaptation.