Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Summited Whitney, and an AMS story...

romanandrey,

I'm not aware of any source that says 100% of people at altitude, moderate altitude, or high altitude acquire AMS and can thus be considered to have mountain sickness. (This would certainly be true at extreme altitudes, but that's irrelevent to this conversation.) If anything, it is now universally agreed that AMS is completely preventable. Too many people use the "everyone gets it" adage as an excuse to ignore symptoms and continue to go higher. In the words of the Himalayan Rescue Association: "Just what causes some people to suffer from AMS but not others is largely unknown ... [but] there is little doubt that altitude illness is one hundred percent a preventable illness. No one should die from it."

http://www.himalayanrescue.org/hra/altitude_sickness.php#acute

Ram,
My son, his friend and I were the three folks that crossed your path at 1 a.m. on our way up the mountain. You can bet your friend's condition and its cause was the topic of some conversations (as a dad, I want to make sure the boys understood how serious the condition was, and how absolute the rule is that you take care of each other). We never came to a conclusion, but a couple of things you said suggested to me that it could be hyponatremia.

I am by no means an expert, and I had never seen a case of HACE (or HAPE for that matter), but I have seen exhaustion. I had no idea you guys had been on the mountain for 22 hours by the time we met you, but I am sure fatigue played a big role in whatever your friend was experiencing. I asked you if your friend was urinating to determine if he were dehydrated (possible even on cold night hikes, and harder to observe in others), and you indicated he was urinating a lot). That led me to believe he was keeping less of the liquids he was taking in. I had understood (I welcome correction) that a sodium shortage could result in excess peeing because sodium helps the body "bind" the water and without sodium the water is not absorbed.

The discussions on this board seem clearly to lean in the HACE direction. I wish it were possible to get a conclusive answer, because it would help me to understand what I saw and therefore how to deal with it (according to what I understand: if hyponatremia, slowly introduce salt and immediate rest, if HACE then descending toward help is much more important than rest). Particularly because I suggested that you head for Outpost Camp and find a camper willing to allow him to rest in a tent for an hour. If he had HACE that might have been deadly, to leave him at 10,000 feet where the swelling could continue.

I am just glad things worked out.....

Justadad,

I can't thank you enough for the support and advice that night. You were the first human contact we had, after 9 hours from the summit - it gave us a big mental boost talking to you friendly people!

It was difficult to identify at that time what he was suffering from - our only knowledge was from a few helpful sites (including this forum), but reading about it is different from actually seeing it!

Several posts here refer to taking salt or sodium as the cause/remedy for electrolyte imbalances. While sodium is one major electrolyte that is lost when sweating, there are others that are equally (arguably more) important. If you read the labels on the better sports drinks (Cytomax would be one example) you will see that they contain almost double the weight of potassium per serving than they do sodium (though that is somewhat misleading because potassium has almost double the molecular weight of sodium, so there are roughly equal numbers of sodium and potassium molecules per serving). There are much higher levels of potassium than sodium inside your muscle and nerve cells and this needs to be maintained in order for your muscles to work. One of the other effects of low potassium is that it can cause the body to produce less insulin, which means that the sugar in your blood gets more slowly into the cells like muscles and nerves. There are also small amounts of other electrolytes that should be maintained.

A number of the sports drinks, gels, powders and even electrolyte capsules contain what is believed to be the appropriate mixture of different electrolytes to replenish what you lose during exercise and sweating. If you are sweating and drinking a lot while climbing, you may find these to help you climb better.

All,

I have a question for AMS. A group of us plan to hike Mt. Whitney from Cottonwood Pass in 2 weeks. 2 weeks ago, we hiked up Mt. Data (13050 feet) as a dry run. During the trip, I started to feel light headache at 12500 feet but went away very quick. I continued on and reach the summit with no problem except light headache on and off. But when I descent to 11600 feet, it started to get worse but it is still no big deal. I returned to base camp, then went to restaurant for diner, I felt the worst when I am waiting for the meal. But after the diner, the headache went away magically. I am kind of recharged completely.

I think I am a little bit dehydrated at last 1-2 hours. The people in our group have the similar experience. The common symptom is than we got headache or headache got worse after descending. We camped one night at 8600 feet before the trip.

What is the reason for this?

Thanks

Sierra Sam,
While it's true that sodium levels are much lower in intracellular fluids and potassium levels are much higher, it is the extracellular fluid that would provide the "sweat", and in this fluid compartment the above mentioned concentrations are reversed. If a person was losing water from sweating they would lose far more sodium than potassium. If a person was losing water from vomiting or the runs, they might have a potassium imbalance. Low sodium in the plasma (hyponatrEMIA=blood)means cells (including neurons) will swell as water diffuses across cellular membranes (osmosis)and I think this is what causes the neurological symtoms. I am not sure that I am absolutely correct on this but this is my understanding of it. Also, I don't think low potassium causes the body to produce less insulin, I think that the insulin receptor on the cell requires potassium as a co-transport molecule. Also, and I can't remember if this is exactly correct but I believe neurons are the only cell in the body that do not require insuliin to facilitate the uptake of glucose (can't remember if that is related to the blood brain barrier or not - sorry).

In all my years I've never seen someone sick from an "electrolyte imbalance" but I've seen lots of people barf from salt tablets. I do some ultra-distance cycling and I've raced a bit, and I agree that sports drinks have helped me on many occasions.

Hard to say Mt Hiker but a headache is very consistent with dehydration. Especially one that persisted after coming down from elevation. As you can see by the responses there are lots of theories and posibilities but almost impossible to diagnose without blood/urine samples. In the case of HACE and HAPE it would take MRI or CT scan to accurately diagnose. Otherwise it is just educated guess's based on history and symtoms.

DryFly,

I'm going to issue a clarification here. I want to stress that AMS is a very serious condition, and I don't want to give any impression that I believe otherwise.


I certainly don't want to encourage people to ignore AMS symptoms. However, I do believe people traveling from sea level to Mt. Whitney should expect AMS symptoms. The question is, what should they do next?

"Acclimatize as much as possible" is good advice.

But the recommended rate of ascent is generally given as 1000 feet per day, turning a Whitney climb into a 2 week expedition for the average California hiker. Few have that kind of free time to spare.

I therefore think it is realistic to suggest that 'everyone' (most people) will experience AMS symptoms on their Whitney climb. They should be expecting it, watching and waiting for it, and constantly assessing and reassessing what to do about it.

If people begin their Whitney hike expecting AMS symptoms, it is my hope that rather than ignoring them, they will be more likely to pay attention to them--and more likely to make difficult choices in the field when it comes to balancing safety with their desire to summit.

Andy

Based on the input in this thread, I corrected the Wikipedia entry for HACE to note that the symptoms sometimes can appear even after a few hours at high altitudes. Since Wikipedia is used by hundreds of thousands (if not millions) of folks, I would not like to add anything that may not be true. Please correct me if that is not an accurate statement.

Thanks!

There was a HAPE case this past Sunday on the Main trail that required helicopter evacuation from Trail camp. I am surprised that this has not been mentioned yet. The person involved seemed to be sluggish and tired, but not all that far out of character for the long hard single day hike up the Main Trail… He was coherent and in good spirits on the summit just 30 – 45 minutes before the trouble started.

Although Mt. Whitney is a strenuous slog, I don't believe the fellow had an electrolyte problem. I sweat a lot and on my two trips to the top, my perspiration was light to moderate because of the cold air and the slower pace. However, when I hike in warm weather I take a can of V-8 juice, which has plenty of sodium and potassium. Most people puke when they take salt tablets without eating food.

There is a solution for HAPE! Viagra!
http://www.sciencedaily.com/releases/2006/06/060624120556.htm

A friend was on the Mt. Everest trek recently and a doctor there is recommending Viagra.

Your understanding of electrolytes as well as electrolytes in sweat is incorrect. You may not have heard that the original Gatorade formulation came from a scientist measuring the contents of sweat in University of Florida football players who constantly had heat problems. Here is one citation about electrolytes in sweat:

Aviat Space Environ Med. 1976 May;47(5):503-4.

Potassium losses in sweat under heat stress.

Malhotra MS, Sridharan K, Venkataswamy Y.

Six healthy, heat-acclimatized subjects were exposed to different hot and humid environments in a climatic chamber and sodium, potassium, and chloride concentrations in their sweat, urine, and blood were determined. The concentration of potassium in sweat was found to be considerably higher than that in the plasma, whereas that of sodium and chloride was very much lower. The concentration of potassium in urine was also 8-12 times higher than that in the plasma as compared to 0.5 to 1.5 times higher for sodium and chloride. The total daily computed losses of potassium in sweat and urine, of a person working in severe heat in the tropics, can be about 116 mEq as against a dietary intake of 97 mEq/d, thereby resulting in negative potassium balance. The potassium depletion in sweat, even in acclimatized Indians, is thus heavy and is likely to play an important role in the causation of heat-illness.