High Altitude Sickness in Latin America

HIGH ALTITUDE SICKNESS

by Gustavo Zubieta Sr., M.D. and Gustavo Zubieta Jr., M.D.

Knowledge of what precautions should be taken is very useful for any change from one environment to another. Don’t be afraid of high altitude. However, be well informed and take proper precautions. Our experience over many years dealing with high altitude disease will prove most useful to you. This advice is mainly for traveler going to high altitudes (such as La Paz, Bolivia) and not necessarily for mountain climbers, although similarities do exist.

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It is important to mention not to underestimate psychological factors. Exaggerated fear constitutes stress and therefore a great loss of energy. Don’t waste your energy as it is fundamental for adaptation to higher altitudes. While it is very complex how fear works on the organism it should be noted that it can cause a fast pulse as if you were exercising. The high altitude affects you because the low barometric pressure causes the air to become thinner. Some individuals don’t have the capacity to adapt immediately to this lower pressure of oxygen that enters their lungs. When supplementary oxygen is given it is increasing the concentration of the gas in the lungs. This compensates for the deficit of oxygen that is required by the organism to metabolize nutrients and convert them into energy.

KEY FACTS ABOUT TRAVELING IN HIGH ALTITUDE AREAS:

1. Always take simple precautions of using basic hygiene. Your organism is immune to the bacteria and viruses that surround you in your usual habitat and not to those of a new environment. You should not ingest unknown foods in great amounts at the beginning of your arrival. Digestive enzymes develop a specific capacity and function for each type of food. Although some foods taste very good, don’t stuff yourself the first day. Also, tobacco and alcoholic beverages should be avoided.

2. Adjustment to high altitude is complex and will vary greatly between individuals. Some people show no symptoms and will eat, drink and exercise. However your tolerance to high altitude does not depend on your physical strength. In fact, we have seen some athletes who have suffered high altitude pulmonary edema (HAPE) upon arriving in a high altitude location. We learned that often they had suffered as children from pulmonary disease that after recovery was asymptomatic at sea level.

3. The effects of high altitude also depend on the distance that you have to travel and or the differences of season. It may also depend on the temperature and the time of day of your arrival. Cold weather aggravates the high altitude effects. High altitude is like an allergy to a certain food. Some people will have a bad reaction and other won’t.

The following information is aimed at those coming to the height of the center (3,600m) of the bowl shaped city of La Paz, Bolivia (3,000m to 4100M). An escalation of just 500 meters or more creates great differences in reactions and newcomers should take additional precautions.

After the critical height of 3000 meters the effects of altitude grows exponentially. The La Paz airport (El Alto) is at 4100 meters. Upon your arrival you should avoid all unnecessary inconveniences that take a long time and descend to La Paz as soon as possible without rushing. Arriving at a good hotel will provide you comfort and security.

Some of the precautions you take will depend on your symptoms. You may notice a slight headache, particularly at the temples. You may also feel a sensation from a lack of oxygen with pressure in the chest region that may last several hours. There is also a possibility of vomiting. This will alleviate the heavy feeling of indigestion and will make you later feel better. If these symptoms persist or worsen during the first 12 hours of arrival take an analgesic (aspirin or paracetarnol). Also rest in bed and cover yourself with a blanket.

If the symptoms continue for 24-48 hours and prevent you from sleeping don’t panic. Call a physician (preferably a high altitude specialist). The more serious cases should receive adequate medical attention and a precise diagnosis. High altitude sickness generally is associated with some chronic affection that surfaces with hypoxic stress (oxygen reduction). In many cases the manifestations of sickness at high altitude are due to overlooked health problems at sea level. Once diagnosed and treated you may return home in better condition than before traveling.

Children adapt best to the change in altitude. Paradoxically they also have a greater susceptibility to suffering from High Altitude Pulmonary Edema (HAPE). There is a 1% incident rate which can be fatal unless medical help is sought. Symptoms include: shortness of breath, rapid pulse, phlegm that may be blood stained and maybe blue lips. In four out of five cases the tongue is white with red spots (ulcers) of varying sizes. They go away when the condition improves. The therapy is generally based on oxygen therapy and rest.

Another affliction that rarely presents itself is High Altitude Cerebral Edema This may involve blurred vision, not being able to walk straight, dizziness, lack of coordination and disorientation. In severe cases you would suffer delirium and coma. In this case you should seek immediate medical treatment.

All those who travel to high altitudes should know that the organism is subject to a series of adaptive mechanisms in its new environment. This is valid for well adapted high altitude residents, like those born in La Paz or in the Altiplano region (3000m-4000m). These are usually individuals who need to go to the mines or panoramic areas like the ski resort Chacaltaya (5200m) or La Cumbre (4600m) on the way to the Yungas valley (600m).

No specific medication is as yet known for severe cases of acute high altitude sickness (also known locally as Sorojche). The diuretic acetazolamide (diamox) has been recommended to prevent acute illness. It should be taken one day before ascent to a high altitude as a prophylactic. It is not 100% effective and you should consult a physician prior to its use. Following some of the basic rules stated above should help you in the event you suffer from this sickness.

Gustavo Zubieta, Sr. M.D. and Gustavo Zubieta, Jr. M.D. practice medicine in La Paz, Bolivia and operate IPPA- High Altitude Pathology Institute. They are located at Ave. Saavedra 2302 (P.O. Box 2852) La Paz, Bolivia. Phone: 591-2-368734 – Fax: 591-2-357159.

Selected Cities in Latin America Where Precautions May Be Needed concerning altitude:

Bogota, Colombia – 8678 ft.

Cajamarca, Peru – 8662 ft.

Cochabamba, Bolivia – 8367 ft.

Cuenca, Ecuador – 8301 ft.

Cuzco, Peru – 10581 ft.

La Paz, Bolivia – 12001 ft.
This article was originally published in Latin America Traveler, September/October 1996. Copyrighted- May not be copied, transferred, sold, or used for commercial purposes unless prior written permission has been granted from Crowder Publications