Welcome to Nepal - high altitude problem

Over the next few weeks our blog will be coming to you from Nepal as I am undertaking a placement within Pokhara emergency department and within surrounding villages. Having just arrived in Kathmandu, and monsoon season in full swing, I thought I would take the opportunity to look over common conditions within the area. Although COPD and ischaemic heart disease are most common causes for mortality within Nepal, my research took a bit of a different turn into the Himalayas and those who work as porters, trek staff and those visiting to experience this magical yet deadly mountain range. The most common illness was high altitude pharyngitis/bronchitis and affected both porters and western trekkers equally. The Khumbu cough is the local name for a dry hacking cough that is experienced by the majority of climbers and is due to the low humidity and temperatures associated with high altitude. This can be so severe it can result in rib fractures.

High altitude illnesses (>1,500m) are primarily caused by hypoxia but in combination with cold and exposure. At high altitude T lymphocyte function is mildly reduced and the body’s ability to fight off bacterial infections is compromised, although resistance to viral infection is not affected. The full mechanism of which high altitude predisposes someone to respiratory infections is not fully understood. Prevention can be achieved through keeping the head warm, hydration and breathing through a silk scarf in order to keep the air humidified. Respiratory infections can predispose climbers to acute mountain sickness and if this does develop after a respiratory infection then further ascent can be fatal. This is due to the progression to high altitude cerebral oedema or pulmonary oedema which may occur. In locals, respiratory infections must be differentiated from an underlying cause such as COPD and cor pulmonale which are becoming increasing more common within the mountain population of the Indian subcontinent.

I am due to start placement within Pokhara on Monday so look out for blog posts about experiences along the way and maybe some clinical experience of high altitude related conditions.

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