The Pharmaceutical
Journal Vol 266 No 7149 p718-722
May 26, 2001
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The Pharmaceutical
Journal Vol 266 No 7149 p718-722 |
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RPM |
Travel medicineTips from a trekking pharmacistFrom Ms A. G. Goward, MRPharmS I have enjoyed Dr L.Goodyer's excellent series of articles to help travellers. Having trekked in the Himalayas three times, to a maximum altitude of 4,700m (15,000ft) and walked the Inca trail to Machu Picchu, over a pass at 4,000m (13,200ft), I would like to add the following points learned first-hand. The loss of sodium and fluid from large body surfaces was well illustrated by the collapse of two bulky six-footers on trek in Nepal. Hyperkalaemia increases the problem of sodium and water loss leading to cramps, paraesthesia, listlessness, mental confusion and muscular weakness. In extreme cases it could lead to paralysis, hypotension, cardiac arrythmias, heartblock and cardiac arrest. People taking potassium-retaining medicines — angiotensin converting enzyme inhibitors, angiotensin-II receptor antagonists and potassium- sparing diuretics — are susceptible to the problem. Leg cramps and muscle weakness are usually the first signs. Drinking plenty of water will help prevent the problem, with a little salt added if symptoms begin. Usually these hypertensive patients have been advised to reduce salt in their diet and may be using potassium- containing salt substitutes. These problems may be further exacerbated by loss of fluid due to diarrhoea, so advice on treating this and taking suitable antibiotics to treat gastrointestinal infections where appropriate (ciprofloxacin and metronidazole) may also be helpful. Excess use of medication to decrease gut motility may lead to vomiting. There is really no substitute for recognising the symptoms of acute mountain sickness. These together with recommended rates of ascent and acclimatisation are well documented in some trekking guides, eg, ‘Trekking in the Everest region' by Jamie McGuiness (Trailblazer Publications, 1998). Certainly the swift ascent by air from Ariquipa at 2,360m (7,740ft) to Puno, Lake Titicaca at 3,856m (12,650ft) in Peru induced headache and nausea in most of the travellers I saw. I found the coca leaf tea recommended by locals to be so unpalatable that it increased the nausea, though some fellow travellers thought it beneficial. Aspirin and ibuprofen are recommended in some manuals to alleviate the mild symptoms of headache and nausea. However, both will irritate the empty stomach and cause nausea. Ibuprofen may worsen the condition by increasing fluid retention. In my experience the headache was not relieved by paracetamol or paracetamol/ codeine combinations but responded better to sipping plenty of fluidsand by raising the shoulders and head. Our local sirdar in Nepal advised against the prophylactic use of acetazolamide (Diamox), which might mask early warning signals, but to ascend at rates which effected acclimatisation, drink eight litres of water a day and keep the head warm. Certainly the effects of ascending too quickly and ignoring “mild symptoms” could be seen all too often last October in the Khumbu region of Nepal: expensive helicopter evacuations and body bags are not a pretty sight. Another piece of good advice for travellers is to have adequate insurance cover for medical emergencies and air evacuation. Geraldine Goward |
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