Jifm-3

DEATHS DUE TO RAPID HIGH ALTITUDE CLIMBING
(ASCEND)
Dr. (Mrs.) S. Dhillon, PG Student, Deptt. of Forensic Medicine, Indira Gandhi Medical College, Shimla.
Dr. V.K. Mishra, Professor & Head, Deptt. of Forensic Medicine, Indira Gandhi Medical College, Shimla.
Dr. Urmil Gupta, Professor & Head, Deptt. of Physiology, Indira Gandhi Medical College, Shimla.
ABSTRACT
High altitude pulmonary edema develops in people who make a rapid ascend to a high altitude and the body is not able to acclimatize itself. We came across two such cases in the department of ForensicMedicine at I.G.M.C, Shimla.
Key Word: HAPE
INTRODUCTION
dry cough-high altitude hack which may be badenough to crack a rib. Hypoxia also causes the heart to beat faster driving more blood throughout mountain has probably felt some altitude effects.
the body to hungry cells. The brain, which makes People ascend to mountains during holidays for only 3% of total weight, uses 20% of oxygen; the trekking and big multinational companies hold brain is likely to suffer when the supply is short.
meetings away from cities so that their officers can Body tries to balance acid-base alterations by 2, 3 relax and enjoy themselves besides working. If the ascent is fast and the body fails to adjust to the increased number of red cells produced by the changed scenario a holiday can turn into a marrow thus increasing the amount of oxygen blood nightmare. Although air everywhere contains 21% can carry. Hypoxia increases blood pressure in oxygen, the atmospheric pressure decreases as arteries supplying the lung, if this increases too altitude increases so less and less oxygen becomes much fluid leaks from blood into lungs causing high available to human body due to fall of oxygen altitude pulmonary edema, which can be rapidly tension in inspired air as well as the alveolar air.
fatal, drowning the victim in his own juices. The Water vapours exert a tension of 47 mm Hg at all delayed effect is hypertrophy of right side of heart altitudes and carbon dioxide is continuously so that blood can be effectively pumped through excreted from the body into respiratory alveoli.
the expanded capillary bed of lungs. Kidneys Because of this combination, the oxygen of the excrete alkaline urine, urea content is more and alveolar air falls at high altitude [1]. This usually happens when there is rapid ascent to altitudeabove 2500 meters or around 8000 feet [2]. The If the mechanism fails there will be hypoxia body uses many strategies to cope up with the lack induced endothelial dysfunction leading to of oxygen, without these strategies high altitude vasoconstriction along with clinical signs of headache, light-headedness, weakness, trouble insleeping, upset stomach, loss of appetite. The Since the reporting of HAPE by Dr. Charles person becomes exhausted sits to rest and may Housten, the compensatory mechanisms adapted not wake from fatal sleep of hypothermia.
by the body were categorized into immediate andother little delayed. The first and most effective change is hyperventilation, which bring more fresh presented, are in reference to high altitude air deep into lungs and washes out carbon dioxide pulmonary edema with history of rapid ascent to thus increasing the available oxygen. With each Shimla, which is to a height of 2159 meters, or breath a climber losses fluid and becomes more 7400 feets. The highest point is Jakhu hill at a height easily dehydrated breathing dry air causes painful There are studies to suggest that the allelic variantsof adaptation and HAPE are on the same locus of genes. If the signs of headache, weakness, trouble Tamil Nadu by train on 22-09-04 at 6.00 am. He sleeping appear stop ascending to high altitude or along with his friends went to Potato Research go back to low altitude until the symptoms go away.
Institute, Bemloi. On coming back, he decided to The more severe symptoms are difficulty even while take rest before going for a walk to The Mall at 2 resting, coughing, and inability to walk in straight pm. At 2 pm, his friends went to call him and he line. The person should immediately go to a lower was found unconscious. He was declared brought Post mortem finding: On examination froth Acetazolamide helps in saving valuable lives (5).
in nose and mouth was present. On internal They are useful in preventing as well as in treating examination, cerebral edema was seen. On cut high altitude pulmonary edema. People can die of section of lungs, gross frothy discharge was high altitude pulmonary edema if the symptoms present. Trachea and lungs contained froth besides congestion of liver, spleen and kidney.
The physical exertion during first 24 hrs is important factor, which add upto the problem (6).
People with sickle cell anemia should not go to high A 40-year-old man came to Shimla from Delhi altitudes and the parents should take care of small on 28-10-04 night for making sweets at a local shop.
children who are being taken to high altitude as On 31-10-04, he complained of chest pain and their bodies have hard time adjusting to low oxygen restlessness. He was found unconscious, brought level. A high altitude is also dangerous for people to I.G.M.C Shimla, and was declared brought dead.
with severe lung disease, such as chronic examination, no injuries were found on the body.
emphysema and for people with severe heart Froth was present in Larynx and Trachea. Gross disease. Some experts recommend that pregnant congestion and froth was present in both the lungs.
women should not travel to an altitude above 8000 Viscera analysis was negative for chemical References
DISCUSSION
Chatterjee CC. Textbook of Physiology. 10th Whenever there is a history of sudden death the foremost cause thought is the involvement of cardiovascular system. The incidence of the mentioned cases may be low but cannot be ignored.
The try should be that the people should be awareof the symptoms.
Ahsan A, Charu R, Pasha MAU, et al. Enosalleve variants at the same locus associate To prevent high altitude illness one should with HAPE and adaptation theory. BMJ 2004; take time travelling to high altitude. When one travels to high altitude body starts adjusting rightaway to the lower amount of oxygen in air, but it American Academy of Family Physician. High takes several days for the body to adjust completely.
altitude illness: How to avoid it and how to If one is healthy, one can probably go safely from sea level to high altitude. The closer one lives to Bhalwar R, Singh R, et al. Nested case control sea level the more time body takes to get use to analysis of risk factors for high altitude high altitude. One should not ascent faster than 1000 feet per day. If one skis at an elevation of 10000 feet during the day, he should sleep the nightbefore and night after at an elevation of 8500 feet.

Source: http://www.forensicindia.net/forensicindia.com/journals/jiafm/t05/i3/jalt05i3p190.pdf