Mountain sickness

Mountain sickness or altitude sickness occurs as a result of lower oxygen at higher altitude along with reduced air pressure. It is a series of symptoms such as dizziness, headache, nausea and loss of appetite.

Acute Mountain Sickness (AMS) is a mild form of Altitude sickness which is caused by climbing to greater than 8000 feet (2400 meters above sea level). Hypoxemia - the hypoxia resulting from high altitude, in susceptible individuals can occur owing to poor acclimatization. High Altitude Pulmonary Edema (HAPE) is a serious condition that may affect people prone to Acute mountain sickness. This edema is the accumulation of fluid from pulmonary blood vessels in lungs. This results in shortness of breath, rapid pulse and cough with bloody sputum. If not treated in time, coma and then death might be a possibility.

High Altitude Cerebral Edema (HACE), though rare is the most life threatening form of Altitude sickness where cerebral edema occurs with symptoms other than those of Mountain sickness can include severe headache, loss of coordination, speech abnormalities, altered level of consciousness and seizures. This condition is fatal unless treated in time. Treatment begins with descent to a lower altitude and oxygen therapy. It is suggested to take Dexamethasone to reduce cerebral edema.

Mountain sickness happens with those who have tried to reach faster. If a person suffering from a severe episode of altitude sickness, problems such as shortness of breath, cyanosis, chest constriction and inability to walk might be noticed. It is easier to treat the early signs of mountain sickness. Returning to lower altitude is the safest step. Additional oxygen must be given. Severe symptoms that might arise are pulmonary edema, cerebral edema or retinal hemorrhage. Rest and oxygen usually helps most persons suffering mountain sickness. Aspirin can be taken for headache but sleeping medications must not be taken as they can slow down breathing. A diuretic like Acetazolamide is prescribed. High altitude edema is best treated with Nifedipine.

Diuretics

Also called as Water Pills as this group of drugs lower the blood pressure by excreting excess water and sodium. Originally Diuretics enhance the rate of urine excretion - diuresis. These drugs are prescribed for the treatment of hypertension, (High blood pressure), Congestive Heart Failure (CHF) and Edema, a condition in which excess fluid is accumulated in the body tissues.

Even caffeine, alcohol and some fruit extracts and juices like that of cranberry juice have mild diuretic effect.

Types of Diuretics

Loop type diuretics:

• Furosemide
  - brand name Lasix
  
• Bumetanide
  - brand name Bumex
  
• Torsemide
  - brand name Demadex
  
• Ethacrynic acid
  - brand name Edecrin
  
  

• Spironolactone
  - brand name Aldactone
  
• Triamterene
  - brand name Dyrenium
  
• Amiloride
  - brand name Midamor
  
  Thiazide Diuretics:
  
• Methyclothiazide
  - brand name Aquatensen
  
• hydroflumethiazide
  - brand name Diucardin
  
• Chlorothiazide
  - brand name Diuril
  
• Hydrochlorothiazide
  - brand name Hydro chlor
  

Sometimes a combination of the diuretics like hydrochlorothiazide and triamterene is also prescribed.

Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus, also known as Acquired Nephrogenic Diabetes Insipidus (ANDI) and Congenital Diabetes Insipidus is a form of diabetes insipidus which is due to the pathology of the kidney. This is in contrast to the central and Neurogenic DI which are due to insufficient levels of ADH or Anti diuretic hormone. Nephrogenic diabetes insipidus is caused by improper response of the kidneys to ADH and this leads to disability of the kidney to concentrate the urine by removing the water. Defect in the small tubes or tubules in the kidneys causes the patient to pass large amounts of urine. In normal persons, the tubules allow water to be removed from the kidneys and returned into the blood, without leaking the urine.

Causes of Nephrogenic Diabetes Insipidus

NDI occurs when the kidney tubules do not respond to a chemical in the body called ADH, also called vasopressin. It is ADH which tells the kidneys to make the urine more concentrated. Due to this, the kidneys release excessive amount of water into the urine and produce large quantity of very dilute urine. NDI is rare. Congenital diabetes insipidus is present during birth. Women can also pass this gene to their children. Other possible reasons of NDI are blockage in the urinary tract, low potassium levels, high calcium levels and use of certain drugs like lithium, demeclocycline, and amphotericin B.

Signs and symptoms of NDI

Intense and uncontrollable thirst and craving to drink ice water.
Large amounts of urine, usually 3 to 15 liters a day.
If sufficient intake of water is not done this could result in dehydration, dry mucous membranes, dry skin, sunken appearance of eyes, and sunken soft spot in infants. Other symptoms of inadequate fluids intake include fatigue, muscle pains, rapid heart rate weight loss.

A physical examination by a doctor would reveal low blood pressure, rapid pulse, shock and signs of dehydration. Diagnostic tests would reveal:

Osmolality of high serum
High urine output
Kidneys do not concentrate when the person is given ADH
Low urine osmolality and
Normal or high ADH levels.

Other diagnostic tests that are done include Serum sodium, 24-hour urine volume, Urine concentration test and Urine specific gravity

Treatment for Nephrogenic Diabetes Insipidus

Patients are normally given large amounts of fluids as the goal of treatment is to control the body's fluid levels. Amount of fluid given is equal to the amount of urine produced. Not keeping up with the fluid can lead to dehydration or electrolyte imbalance. Sometimes NDI is caused due to certain medication, and therefore stopping the medicines may improve symptoms. Hydrochlorothiazide may improve symptoms. This is prescribed alone or in combination with other medications. Although hydrochlorothiazide is a diuretic, it can actually reduce urine output for people with NDI. Some treatments which can reduce the symptom of nephrogenic diabetes insipidus are low salt, low protein diet and NSAIDs.