關於 high altitude sickness ，我們在網路上蒐集到這些相關的討論、資訊與評價

【文獻閱讀】～ 快速上升到海拔3500公尺以上的高山症預防用藥劑量

今天是軍人節，來點和軍人有關的高山症研究吧⋯⋯

這篇是今年3月的文獻綜述（review article），想解決的問題是對於軍隊或是急難救助人員，常常因為任務需要，一下子會到高海拔活動；如果要預防急性高山病（acute mountain sickness, AMS），使用丹木斯的劑量要多少才夠。

先說結論好了，文獻中建議，如果你要快速上升到3500公尺以上的海拔，預防性藥物劑量要在500毫克～750毫克/天。（目前市面上一顆丹木斯為250毫克，所以就是一天要吃2～3顆）

＊ 平常我們休閒登山，使用丹木斯的預防性劑量為：上升至2500公尺前12小時開始投藥，每12小時125毫克，也就是12小時吃半顆。

＊＊所以一般人應該不會用到這樣高的劑量！畢竟沒有幾個人會早上起床後，一時興起，晚上就在奇萊北峰看看銀河吧⋯⋯XD

而且這樣吃很容易出現丹木斯的副作用：「過度換氣」，就會有手指、腳指末端麻麻的，甚至會有對於碳酸飲料的味覺異常（沒錯，如果你吃了丹木斯，在高山上覺得喝自己辛辛苦苦背上來的可樂，味道怎麼和平地不一樣，不要太驚嚇⋯⋯）

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最後再碎碎念一下，希望不要剛開學就停課呀！對，我說的就是今天這例突破性感染後，傳給家中小朋友，又去上課的事情。

大家記得即便去爬山，在人多的休息點，或是和山友擦肩而過時，都記得把口罩戴好唷！在山區用餐時，也儘可能自備，不要共食，保持社交距離，減少邊吃邊聊天。畢竟沒人想害到一樣愛山的朋友，更沒人想再回到三級警戒的日子。

（偷渡這段在中間，有人會看到嗎？好奇統計一下，有緣人話個蝦）
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〖文獻來源〗

Toussaint, Claudia M., et al. "Altitude, Acute Mountain Sickness, and Acetazolamide: Recommendations for Rapid Ascent." High Altitude Medicine & Biology 22.1 (2021): 5-13.

http://doi.org/10.1089/ham.2019.0123

【藥事知多D】一物三用：Acetazolamide

一種藥偶爾可能會有多種截然不同的用途。
　　
例如Acetazolamide。
　　
那Acetazolamide到底有什麼用途呢？
　　
常用的用途一般主要有以下三個：

一、高血壓
　　
首先Acetazolamide是一種碳酸酐酶抑制劑(Carbonic Anhydrase Inhibitors)，主要透過抑制腎臟裡面近曲小管(Proximal Convoluted Tubule, PCT)的碳酸酐酶(Carbonic Anhydrase)，便可能會促進鈉、重碳酸鹽(Bicarbonate, HCO3-)、氯(Chloride, Cl-)的排泄，因為「鈉跟著水走」，水分便會隨著鈉質排出體外而降血壓。
　　
對，在相當程度上，Acetazolamide是一種利尿劑(Diuretics)。

二、青光眼
　　
Acetazolamide還能夠透過抑制碳酸酐酶抑制眼球裡房水(Aqueous Humor)的分泌，從而可能會降低眼壓(Intraocular Pressure, IOP)，從而能夠紓緩青光眼的症狀。

三、高地綜合症(High Altitude Syndrome)（俗稱「高山症」），例如急性高山症(Acute Mountain Sickness, AMS)
　　
因為Acetazolamide能夠促進重碳酸鹽的排泄，便可能會增加尿液的酸鹼值而偏向鹼性，變相可能會降低血液的酸鹼值而偏向酸性，從而可能會促進呼吸的速度、深度，目的在透過促進二氧化碳的排放盡量扳回血液酸鹼值，便可能會增加體內氧氣的水平，便可能會改善上刀山……不、不、不，應該是上高山的適應力[1]，從而可能會預防急性高山症。[2]

（如欲了解更多用藥資訊，歡迎看看「小小藥罐子」網誌。）

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著作➡️藥事知多D、用藥知多D、藥房事件簿、家居用藥攻略（各大書店有售）

Reference:
1. Leaf DE, Goldfarb DS. Mechanisms of action of acetazolamide in the prophylaxis and treatment of acute mountain sickness. J Appl Physiol. 2007;102(4):1313-22.
2. Bradwell AR, Wright AD, Winterborn M, Imray C. Acetazolamide and high altitude diseases. Int J Sports Med. 1992;13 Suppl 1:S63-4.

剛好昨天有去合歡山追雪3歲小孩發生高山症的新聞，所以簡單介紹一下高山症，分成以下三大類：

1️⃣#急性高山病(Acute mountain sickness; AMS)
👉🏻症狀：因缺氧出現頭痛、頭暈、失眠、噁心、嘔吐、厭食、虛弱等症狀，一般人到達高海拔地區1~12小時後開始出現症狀，症狀2~3天後會隨著身體適應環境而緩解。通常最先出現的是頭痛，⚠️ #嘔吐是症狀惡化的重要指標。

2️⃣ #高海拔腦水腫(High-altitude cerebral edema; HACE)，少數高山症會惡化為高海拔腦水腫
👉🏻症狀：嚴重頭痛、嗜睡、意識不清、運動失調(步態不穩)、甚至昏迷。
⚠️ #步態不穩是高海拔腦水腫的重要指標，若沒有治療24小時內就可能致死。

3️⃣ #高海拔肺水腫(High-altitude pulmonary edema; HAPE)
👉🏻症狀：包括運動能力變差、休息狀態下仍不停喘氣、乾咳、胸悶，甚至呼吸困難、咳嗽帶血、發紺。
⚠️ #高海拔肺水腫的致死率比另外兩種高海拔疾病更高，給予氧氣能緩解症狀，但同時一定 #要立刻降低高度。

❗️治療：
1. #避免快速上升高度，最好先在海拔2000-2500公尺處待1至2天，超過海拔2750公尺後，每天睡眠高度不要爬升超過500公尺。
2. 使用預防藥物：
▶️Acetazolamide(Diamox，丹木斯)是目前一線用藥，可以預防也有治療效果，出發前一日開始服用，每日兩次，每次125mg，抵達後繼續服用兩日再停藥。⚠️蠶豆症不能使用。
▶️類固醇藥物Dexamethasone也有預防及治療效果。
▶️口服Adalat（Nifedipine）、口服威爾鋼Viagra（Sildenafil）：用來預防高海拔肺水腫。
3. ✔️盡量減少劇烈、高耗氧活動 ;
✔️保持身體溫暖，低溫會增加肺動脈壓;
✔️不要吸菸🚬，吸菸會減少吸入的氧氣量，
✔️不要飲酒、服用鎮靜劑或安眠藥，以免抑制呼吸中樞及缺氧換氣反應，
✔️飲食盡量高醣低脂(避免碳酸飲料🥤等產氣食物）
‼️若發生肺水腫、腦水腫：藥物、供應氧氣外，#一定要立刻下降至少海拔500~1000公尺。

⚠️哪些人罹患高海拔疾病的風險比較高？
👉🏻心衰竭、肺動脈高壓、心肌缺氧(心絞痛)、鐮刀形貧血、嚴重的慢性肺部阻塞性疾病、鐮刀細胞型貧血，或孕婦等情形，對缺氧的環境特別敏感，並不適合到高山旅遊。

以下這篇新聞有寫⬇️
除了成人版也有兒童版的路易絲湖急性高山症評分（Children's Lake Louise Score, CLLS）可評估小孩是否有高山症，#主要以是否哭鬧或能玩能吃能睡做評估，建議沒有信心的父母可以避免帶小小孩當天上合歡上追雪❄️⛄️喔～

快樂出遊 安全第一喔☝️☺️

以上資料參考自疾管署

#佳鴻診所

https://www.google.com/amp/s/news.ltn.com.tw/amp/news/health/breakingnews/3407121

EP นี้จะเป็นการ Vlog กับสิ่งที่ต้องเจอเมื่อเรามาถึงที่ Leh Ladakh วันแรกจะเป็นวันที่เมามาก เพราะร่างกายเราจะต้องปรับตัวสู้กับอากาศที่เบาบางเมื่อเราขึ้นมาที่พื้นที่สูง (ระดับเกิน 3,000เมตรจากระดับน้ำทะเลปานกลาง) และมาระเบิดกระเป๋าว่าผมขนอะไรมาที่อินเดียบ้าง

ชมทุกคลิป Moto Himalaya 2019 : https://www.youtube.com/watch?v=1lz-H1R7Rwc&list=PLAQvltjZXo69YkRxKf1IURkh3gszk0yMa&fbclid=IwAR3rRJsACkFeHyjVcvaOqtwhN76MO1tKHEAdiuKNKPSUoxVT5TZKvpbSPVU

ทริปขี่มอไซค์ครั้งหนึ่งในชีวิต นี่คือเส้นทางในฝันของผู้ที่ชื่นชอบการขับขี่มอไซค์ 9วัน 9ร้อยกว่ากิโล 9เชื้อชาติ เป็นทริปที่ผมจะไม่มีทางลืมได้เลย ไม่เหมือนทริปไหนและไม่มีทริปใดเหมือน เจอทุกสภาพเส้นทาง(ไม่อยากเรียกถนน เพราะไม่ค่อยเจอ555) ร้อน หนาว ฝน และหิมะ สู่เทือกเขาหิมาลัยเส้นทางที่อยู่สูงที่สุดในโลกที่ยานพาหนะมีล้อสามารถไปได้ เป็นประสบการณ์ชีวิตที่ประทับใจที่สุด และขอขอบคุณทาง Royal Enfield ที่ทำให้เกิดทริปแห่งความฝันนี้ขึ้นมาครับ ขอบคุณมากครับ

#MotoHimalaya #RoyalEnfield #LehLadakh #RErides #Motohimalaya2019 #Himalayan #india

Learn how to recognise symptoms of mild altitude sickness, as well as the potentially deadly HAPE and HACE (fluid in the lungs/brain). Plenty of advice on how to prepare for the trek, plan a safe itinerary, and what to pack.
Follow our family, including our 11-year old son Lionel, on the Annapurna Circuit in winter. See how the altitude affected us as we climbed Thorong La (5,416 meters/ 17769 feet) – Kirk struggled with his breathing, Lionel felt nauseous, and I had mild hypothermia But we all made it safely in the end.

SUMMARY
*Watch out: some people may feel unwell as low as 2,000 meter (6,500 feet).
*Plan a slower ascent above 3,000 meters (10,000 feet)
*Climb high, sleep low. To be safe, only gain 300 meters (1,000 feet) in sleeping elevation at high altitude.
*If you climb faster than the recommended rate, you can build a rest days every three or four days to acclimatise.
*If you suffer from mild altitude sickness, drink a lot, and rest
*Avoid alcohol, which slows down breathing and makes you dehydrated. Avoid sleeping pills. And smoking will certainly not help!
*If you see no improvement, spend an extra night at the same altitude
*If you feel worse, descend to the last place where you felt well
*If you develop HAPE or HACE, this is a life-threatening emergency that requires immediate descent of and specialist medical care. You may have to descend in the middle of the night, don't wait till morning. Once fluid builds up in the brain or lungs, you can die in a matter of hours.

DISCLAIMER
This video is based on first-hand experience of struggling with the altitude on the Annapurna Circuit. We also spent decades of travelling in the Himalayas and Alps. With three decades in TV journalism, I've also done extensive research on the impact of high altitude.

I am NOT a doctor, and I do not have direct experience of taking drugs for altitude sickness like Diamox / Acetazolamide or Nifedipine for HAPE or the use of Gamow bags for hyperbaric treatment. So I have not included any information on this topic. Only sticking to what I have first-hand experience of.

I hope this video helps you plan a safe and enjoyable trek.

Director/video/editor: Corinne Vigniel
Shot between Bulbhule and Jomsom including
Bahundanda Sanjye Chame Timang Pisang Gyaru Ngawal Manang Yak Kharka Thorong Phedi Thorong High Camp Thorong La Mukhtinath Pokhara
December 14-30, 2016
Shot on Panasonic Lumix DMC-GH3
Edited on Adobe Premiere CC
++All VIDEO AND PHOTOS COPYRIGHT CORINNE VIGNIEL++

MUSIC FOR TOP TEN TIPS FOR ALTITUDE SICKNESS
Downloaded From YouTube creator

Tip 1 training
Opening_Night_Jason Farnham_dance electronic inspirational 1.50

Tip 2 Planning
Cameras_ALBIS_rock inspirational 1.52

3 Gradual Ascent
Keep_Dreaming_Topher Mohr and Alex Elena_Pop calm 2.52

Tip 4. Acclimatisation
Don’t Look _ Silent Partner 4.25

Tip 5 Broken sleep
Keep_Dreaming_Topher Mohr and Alex Elena_Pop calm 2.52.mp3

Tip 6 – Mild Altitude Sickness
AMS
Hot_Heat_Topher Mohr and Alex Elana_rock inspirational 3.09.mp3

7 Danger HAPE HACE
So_Bueno_The 126ers_Rock inspirational 2.56

8 Food and drinks
Hero_Theme_Twin Musicom_cinematic dramatic 1.42 CC credit

9. Equipment
Voyeur Jingle Punks

10 Accidents / insurance + final world.
Accidents_Will_Happen_SIlent Partner
END

Crank up the volume for music and see the Annapurna Circuit through the eyes of a mischievous 11-year old boy. Watch us deteriorate as we drag ourselves over Thorong La 5,416 meters (17,769 feet). We trekked around Annapurna in Nepal with Lionel over Christmas (yes, boy with long hair!). Lionel was really determined to make it and was actually faster and stronger than his parents ... We were all pushed to our limits and left gasping for breath the day we crossed the high pass – but felt a real sense of achievement.

The Annapurna Circuit is widely regarded as one of the top 10 treks in the world. It has an incredible variety of landscapes. You start below 1,000 meters (3,280 ft) in rice paddies and banana plantations, go through pine forests, past Tibetan Buddhist villages, before tackling the high altitude pass of Thorong La. On the other side, you discover the high altitude desert of Mustang and the deepest valley in the world, the Kali Gandaki.

Lots of research and training went into this two-week trek. We love the great outdoors, and Lionel has been a keen hiker from a very young age. We’ve taken several family trips to the Tibetan plateau in winter, and Kirk and I trekked to the Gokyo Lakes in the Everest region 13 years ago. But this was the first time we tackled such a challenge as a family.

Most travel agencies recommend you should not take children above 3,000 meters (9,840 feet). We looked into easier options, including the Annapurna Sanctuary and Kopra Danda – but Lionel was very keen to scale Thorong La. And we felt he was ready to do it, and we had the experience to guarantee his safety. We played it safe, hiring a guide and two porters to help us -- and we would not have been able to make it carrying all the gear ourselves.

Winter offers clear blue skies and stunning views of the Himalayas. You only meet a handful of people every day, and it's easy to get a room in lodges. A total of 60 people crossed Thorong La on Dec 27, and only 30 the next day.

On the down side, it's bitterly cold at night in unheated lodges. And snow storms can cross the pass at any time. This would mean waiting for a few days for the pass to reopen, or turn back and hike for a week.

This is a high altitude trek. Best to resist the temptation to take the jeep road high up, as you increase your risk of suffering from acute mountain sickness. Give yourself time to acclimatise, and watch out for signs of Acute Mountain Sickness (AMS), or worse - HAPE or HACE. It is also essential to have proper equipment to trek in snow, not just for yourself, but for your porters and guide, if you have them.
Remember that over 40 people died around Thorong La on October 14, 2014 when a massive snowstorm hit the Annapurna, Dhaulagiri and Mustang areas. Hiking at that altitude always carries a risk.

We organised this trek through Friends in High Places Himalayan Trekking, who provided a guide (Pasang Dawa Sherpa) and two porters (Sonny and Pinju). We would not have been able to complete this trek without them.

++ALL VIDEOS/EDIT COPYRIGHT CORINNE VIGNIEL++
Location: Upper Pisang, Manang, Yak Kharka, Thorong Phedi, Thorong High Camp, Thorong La pass, Ranipauway, Muktinath, Lupra, Nepal
December 24-28, 2016
Camera: Panasonic GH3
Edited on Adobe Premiere CC2015

Music:
Little Drummer Boy Lyris lyrixpixie
Amazing Grace Pipes And Drums Of The 1st Bn. Scots Guards
Camille Saint-Saëns – Danse Macabre (YouTube Audio Library)
Om Mani Padme Hum Buddhist music
Beethoven - Egmont Overture (YouTube Audio Library)

++ALL VIDEO FOOTAGE COPYRIGHT CORINNE VIGNIEL ++
++MUSIC DOWNLOADED FROM YOUTUBE, SEE CREDITS ABOVE++
END