High altitude illness in pilgrims after rapid ascent to 4380 M

Zafren, Ken; Pun, Matiram; Regmi, Nirajan; Bashyal, Gobinda; Acharya, Bhuwan; Gautam, Subarna; Jamarkattel, Sujan; Lamichhane, Shankar Raj; Acharya, Suman; Basnyat, Buddha

doi:10.1016/j.tmaid.2017.03.002

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…High-altitude environments, accompanied by the typical characteristics of hypobaric hypoxia, strong ultraviolet radiation, low temperature and high humidity, can easily induce pathological damage to various tissues, and in severe cases, can develop into brain or pulmonary edema. Clinical symptoms include headache, light-headedness, insomnia, fatigue and other neurological symptoms, as well as cough, progressive dyspnea and other signs of lung injury (Archer et al, 2020;Wang et al, 2018;Wu et al, 2018;Zafren et al, 2017). Pathological results show that meldonium can significantly improve cerebral blood flow reduction, alveolar dilatation, alveolar interstitial rupture and thickening induced by acute hypoxia.…”

Section: Discussionmentioning

confidence: 99%

Insights into the pharmacodynamics and pharmacokinetics of meldonium after exposure to acute high altitude

Liu¹,

Sui²,

Wang³

et al. 2023

Front. Pharmacol.

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Objective: Meldonium, a well-known cardioprotective drug, has been reported to be protective against pulmonary injury at high altitudes; however, the pharmacodynamics of meldonium in other vital organs under acute high-altitude injury are less investigated and the related pharmacokinetics have not been fully elucidated.Methods and Results: The present study examined the basic pharmacodynamics and pharmacokinetics (PK) in rat exposure to acute high-altitude hypoxia after intragastrical and intravenous pre-administration of meldonium. The results indicate that meldonium can improve acute hypoxia-induced pathological damage in brain and lung tissues, and restore blood biochemistry and routine blood index of heart, liver and kidney tissues under a simulated acute high-altitude environment. Furthermore, compared to the normoxia group, rats exposed to simulated high-altitude hypoxia and premedicated with intragastrical meldonium showed linear kinetics in the dose range of 25–100 mg/kg, with a significantly increase in the area under curve (AUC) and reduced clearance rate. No significant differences in these meldonium of PK parameters were observed with intravenous administration. Additionally, meldonium was involved in the regulation of succinic acid and 3-hydroxypropionic acid.Conclusion: These results will contribute to our understanding of the preclinical PK properties of meldonium and its acute high-altitude protective effects.

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Section: Discussionmentioning

confidence: 99%

Insights into the pharmacodynamics and pharmacokinetics of meldonium after exposure to acute high altitude

Liu¹,

Sui²,

Wang³

et al. 2023

Front. Pharmacol.

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“…Among pilgrims visiting Gosainkunda, a sacred lake at 4380 m, for Janai Purnima festival, the incidence of AMS was found to be 34% [ 7 ]. Another study reported AMS in around 29% patients, including those with HACE [ 8 ]. Study in the Annapurna trekking region showed prevalence of AMS between 34% and 57% [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

High-altitude illness: Menace in Himalayas of Nepal

Lamichhane¹,

Ghimire

Pokhrel

et al. 2022

Annals of Medicine &Amp; Surgery

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“…Apart from the religious zeal, the high cost of lodging and buying meals during pilgrimage may also contribute to rapid ascent. The majority of pilgrims at Gosainkund Lake only stay for one night 4. This sentiment of finishing the pilgrimage as early as possible also contributes to the rapid rate of ascent among the pilgrims.…”

Section: Global Health Problem Analysismentioning

confidence: 99%

Acute mountain sickness (AMS) in a Nepali pilgrim after rapid ascent to a sacred lake (4380 m) in the Himalayas

Thapa¹,

Basnyat

2018

BMJ Case Rep

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A 55-year-old female Nepali pilgrim presented to the Himalayan Rescue Association Temporary Health Camp near the sacred Gosainkund Lake (4380 m) north of Kathmandu, Nepal, with a complaint of severe headache, vomiting and light-headedness. She was diagnosed with severe acute mountain sickness. Intramuscular dexamethasone was administered. Paracetamol (acetaminophen in the USA and Canada) and ondansetron were given as supportive management for headache and nausea. Arrangements were made to have her carried down by a porter immediately. After the descent, all her symptoms resolved. High-altitude pilgrims are a more vulnerable group than trekkers and mountaineers. Pilgrims generally have a rapid ascent profile, have low awareness of altitude illness and are strongly motivated to gain religious merit by completing the pilgrimage. As a result, there is a high incidence of altitude illness among pilgrims travelling to high-altitude pilgrimage sites.

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High altitude illness in pilgrims after rapid ascent to 4380 M

Abstract: HAH and AMS were common in pilgrims ascending rapidly to 4380 m. There were 11 cases of HACE, treated with dexamethasone, supplemental oxygen and descent. There were no fatalities.

Cited by 11 publications

References 10 publications

Insights into the pharmacodynamics and pharmacokinetics of meldonium after exposure to acute high altitude

Insights into the pharmacodynamics and pharmacokinetics of meldonium after exposure to acute high altitude

High-altitude illness: Menace in Himalayas of Nepal

Acute mountain sickness (AMS) in a Nepali pilgrim after rapid ascent to a sacred lake (4380 m) in the Himalayas

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