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 . This usually
happens when there is rapid ascent to altitudeabove 2500 meters or around 8000 feet . 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
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.
Lab order business hours: mo - fr: 8:00 - 19:00 h, sa: 9:00 - 13:00 hfirst name _______________________________________fax/e-mail: _______________________________________: ________________________________________________I have checked animals identity and assure that samples are taken from the animals mentioned above. ____________________________________________ s_- ture / stamp veterinar
Appeal from the United States District CourtBefore BARKETT, ANDERSON and COX, Circuit Judges. Plaintiff Laurie A. Stupak appeals the district court’s grant of summaryjudgment to Defendants-Appellees Hoffman-La Roche, Inc. and RocheLaboratories, Inc. (hereinafter collectively “Roche”). Stupak brought a wrongfuldeath claim against Roche in the state of Wisconsin for the suicide death of h