Pen Paper & A Pulse Oxymeter: Prospective Study of the Effect Acetazolamide Have in Quick Trans-Himalayan Acescent

Title: Pen Paper & A Pulse Oxymeter: Prospective Study of the Effect Acetazolamide Have in Quick Trans-Himalayan Acescent

Authors: Dr Sourav Iswarari MBBS, MD (PM&R), Dr Ushnish Mukherjee MBBS, Dr Rachit Gulati MBBS, Dr Jayanta Kumar Rout MBBS, MD (Biochemistry), Dr Tapobrata Guha Ray MBBS, MD (Community Medicine)

DOI: https://dx.doi.org/10.18535/jmscr/v5i4.09

Abstract

Introduction: Two Bengali mountaineering team of expeditionist one from Kolkata, India other from Bangladesh took part in a study to determine the effect of acetazolamide by easily usable parameters in quick high altitude sojourns .The aim was also to see if data collected can be used by layman expeditionist for meaningfully accessing team’s condition thereby making rational choices in such wilderness.

Materials & Methods: Two expeditions were conducted separately in the same region of Trans Himalayan high altitude deserts of Northern most Spiti in Himachal Pradesh, India. Those who had any acute or chronic illness, patients on regular medications, and those who had sojourns at an altitude > 2500 meters during the previous 4 weeks, age < 20 or > 60 years and hemoglobin concentration < 12.0 g/dL were not involved in the study. Sojourns were attempted at month of July/August in two consecutive seasons. In group 1 from Kolkata 13 subjects were put on acetazolamide. The regimen was to take 125 mg acetazolamide twice daily. In group 2 from Bangladesh had 9 subjects who did not opt for medical prophylaxis by choice. During high-altitude exposure, resting measurements of peripheral capillary oxygen saturation (SpO2), heart rate (HR) and Lake Lewis Score (LLS) were taken in the evening of 1st, 2nd, 5^th day, 6^Th and 8^th day starting from 293 meter and ending in 5200 meter as subjects climbed relentlessly.

Results: Average age in group 1 was 43.08 ± 11.62 years (range: 25 to 65 years) while that of group 2 was 30 ± 4.74 years (range: 23 to 36 years). All were males. RANK tests are done for data which were not normally distributed and analyzed by Man-Whitney U. This showed significant difference of LLS noted between two groups at 3910 m only. The group under acetazolamide prophylaxis showed significant better outcome then ones without it. In independent sample test of parametric data, t-test for equality of means revealed Sp02 (t=4.616 ) and HR (t=-3.486) had highly significant changes .The group who were not given acetazolamide prophylaxis showed comparative increase in HR and decreased Spo2 at that critical altitude which were statistically significant.

Conclusion: Acetazolamide was shown to further the process of acclimatization at a critical time-line and altitude window. The study in the process was able indicate definable relationship between various parameters at different altitudes which were in concurrence with physiological responses.

References

1. John B. West, Robert B.Schoene, Andrew M.Luks and James S. Milledge. Ventilatory response to hypoxia. Robert B.Schoene (ed). High Altitude Medicine and Physiology, 4th edition ed. (London): Hodder Arnold ; 2007. pp. 51-65.

2. Rahn H otis AB. Man's respiratory response during and after acclimatization to high altitude . American Journal Physiology Jun 1949; 3(157): 445-462.

3. Emma V Low, Anthony J Avery, Vaibhav Gupta, Angela Schedlbauer, Michael P W Grocott . Identifying the Lowest Effective Dose of Acetazolamide for the Prophylaxis of Acute Mountain Sickness Systematic Review and Meta-analysis . British Medical Journal 2012; (345): e6779.

4. Van Patot MC, Leadbetter G III, Keyes LE, Maakestad KM, Olson S, Hackett PH. Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness . High Alt Med Biol 2008; 9(4): 289-293.

5. Basnyat B, Gertsch JH, Holck PS, Johnson EW, Luks AM, Donham BP et al . Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial. High Alt Med Biol 2006; 7 (1): 17-27.

6. Ellsworth AJ, Meyer EF, Larson EB. Acetazolamide or dexamethasone use versus placebo to prevent acute mountain sickness on Mount Rainier. West J Med 1991; 154(3): 289-293 .

7. Wagner, P.D. . A theoretical analysis of factors determining VO2max at sea level and altitude. Respir. Physiol 1996; (106): 329–343.

8. Wagner, P.D. Reduced maximal cardiac output at altitude-mechanisms and signify-cance. Respir. Physiol 2000; (120): 1–11.

9. Seals, D.R., Johnson, D.G., Fregosi, R.F . Hypoxia potentiates exercise induced sympathetic neural activation in humans . J. Appl. Physiol 1991; ( 71): 1032–1040.

10. Voelkel N.F., Hegstrand L, Reeves J.T., McMurty I.F., Molinoff P.B . Effects of hypoxia on density of beta-adrenergic receptors. J. Appl. Physiol 1981; (50): 363–366.

11. Richalet J.P. Oxygen sensors in the organism Examples of regulationunder altitude hypoxia in mammals. Comp. Biochem. Physiol 1997; 118(A): 9–14.

12. Christensen E.H., Forbes W.H . Der Kreislauf in grossen H¨ohen. Arch. Physiol 1937; (76): 75–89.

13. Gonzalez NC, Clancy RL, MoueY, Richalet JP . Increasing maximal heart rate increases maximal O2 uptake in rats acclimatized to simulated altitude. J. Appl. Physiol 1998; (84): 164–168.

14. Gonzalez NC, Clancy RL,Wagner PD . Determinants of maximal oxygen uptake in rats acclimated to simulated altitude. J. Appl. Physiol 1993; (75): 1608–1614.

15. Gonzalez NC, Sokari A, Clancy RL . Maximum oxygen uptake and arterial blood oxygenation during hypoxic exercise in rats.. J. Appl. Physiol 1991; (71): 1041–1049.

16. Ulrich S, Nussbaumer-Ochsner Y, Vasic I, Hasler E, Latshang TD, Kohler M et al . Cerebral oxygenation in patients with OSA: effects of hypoxia at altitude and impact of acetazolamide. Chest Aug 2014; 146:(2): 299-308.

17. Swenson ER. Carbonic anhydrase inhibitors and high altitude illnesses. Subcell Biochem 2014; (75): 361-386.

18. Martin Burtscher, Hannes Gatterer, Martin Faulhaber, Johannes Burtscher. Acetazol-amide pre-treatment before ascending to high altitudes: when to start? . Int J Clin Exp Med 2014; 7 (11): 4378–4383.

19. Ried LD, Carter KA, Ellsworth A . Acetazolamide or dexamethasone for prevention of acute mountain sickness: a meta-analysis. J Wilderness Med 1994; (5): 34–48.

20. Cain SM, Dunn JE. Increase of arterial oxygen tension at altitude by carbonic anhydrase inhibition. J Appl Physiol 1965; (20 ): 882–884.

21. Sutton JR, Houston CS, Mansell AL, McFadden MD, Hackett PM, Rigg JR et al . Effect of acetazolamide on hypoxemia during sleep at high altitude. N Engl J Med 1979; (301 ): 1329–1331.

22. West JB. The physiologic basis of high-altitude diseases. Ann Intern Med 2004; (141): 789–800.

23. Teppema LJ, Rochette F, Demedts M . Ventilatory response to carbonic anhyd-rase inhibition in cats: effects of acetazolamide in intact vs. peripherally chemodenervated animals. Respir Physiol 1988; (74): 373–382 .

24. Wagenaar M, Teppema L, Berkenbosch A, Olievier C, Folgering H . The effect of low-dose acetazolamide on the ventilatory CO2 response curve in the anaesthetized cat. J Physiol1996; (495): 227–237.

25. Basnyat B, Gertsch JH, Holck PS, Johnson EW, Luks AM, Donham BP et al . Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial.. High Alt Med Biol 2006; (7 ): 17–27.

26. Wagner, PD. A theoretical analysis of factors determining VO2max at sea level and altitude. Respir. Physiol 1996; (106): 329–343.

27. Severinghaus, J.W.,Mitchell RA, Richar-dson BW,Singer MM . Respiratory control at high altitude suggestive active transport regulation of CSF Ph. J.Appl.Physiol 1963; (18): 1155-1166.

28. Severinghaus ,JW Bainton,CK Carcelen. A respiratory insensitivity to hypoxia in chronically hypoxic man. Respir physiol 1966; (1): 308-304.

29. Lahiri S,Milledge JS . Acid-base in Sherpa altitude residents and low lander at 4800 m. Respir physiol May 1967; (2 ): 323-334.

30. Sutton JR, Houston CS, Mansell AL, McFadden MD, Hackett PM, Rigg JR et al . Effect of acetazolamide on hypoxemia during sleep at high altitude. N Engl J Med 1979; (301 ): 1329–1331.

31. Aoki VS, Robinson SM . Body hydration and the incidence and severity of acute mountain sickness. J Appl Physiol 1971; (31): 363–367.

32. RC Roach, P Bartsch, PH Hackett, O Oelz . The lake lewis acute mountain sickness scoring system. Sutton JR, Coates G, Houston CS (eds). Hypoxia and Molecular Medicine, 1st ed. Burlington,Vermont: Queen City Press; 1993. pp. 272-274.

33. Hillenbrand P, Pahari AK, Soon Y, Subedi D, Bajracharya R, Gurung P et al . Birmingham Medical Research Expediti-onary Society. Prevention of acute mountain sickness by acetazolamide in Nepali porters: a double-blind controlled trial. Wilderness Environ Med 2006; 17(2): 87-93.

34. Basnyat B, Gertsch JH, Holck PS, Johnson EW, Luks AM, Donham BP et al . Acetazolamide 125 mg BD is not significantlydifferent from 375 mg BD in the prevention of acute mountainsickness: the prophylactic acetazolamide dosage comparison for efficacy(PACE) trial. . High Alt Med Biol 2006; (7): 17–27.

35. Andrew M. Luks, Scott E. McIntosh, Colin K. Grissom, Paul S. Auerbach, George W. Rodway, Robert B. Schoene et al . Wilderness Medical Society Consensus Guidelines for the Prevention and Treat-ment of Acute Altitude Illness. Wilderness & Enviromental Medicine 2010; (21 ): 146 –155 .

36. Edward D. Chan, Michael M. Chan, Mall-ory M. Chan. Pulse oximetry: Underst-anding its basic principles facilitates appreciation of its limitations. Respiratory Medicine June 2013; 107 (6): 789–799.

Corresponding Author

Dr Sourav Iswarari

MBBS,MD(PM&R), Associate Professor, Department of Physical Medicine and Rehabilitation, R.G.Kar Medical College and Hospital, Kolkata (West Bengal), India.

Address: Flat A/1, Usashi, Bindubashini Co-operative, Block Q/67, BP Township, Kolkata-94.

West Bengal, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone: +91 9433773111

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles