Diamox baby: I'm high as a kite and you make me all tingly inside

In the last post, I indicated that upon arriving at Machame Camp, 10,000 ft, we were all doing well. That's not entirely correct... we were all jacked up on diamox (acetazolamide) and were experiencing numbness and tingling to various degrees, a known side effect of this medicine. Ajay thought that these neurological manifestations were due to potassium loss, also a side effect of this diuretic. Not exactly sure if I believe that, boss, but just doing a brief search for the mechanism of action didn't turn up anything quick explanations. So the jury is still out.

Many people are aware that diamox is used in the prevention and treatment of altitude illness.
We were all taking the higher doses suggested in the medical literature (see below), 250 mg three times a day. Our guide, Bruce, who's opinion and experience I certainly respected when it came to anything about being on a big hill like Kilimanjaro, stated that these were higher doses than most climbers used. He felt that higher doses like 750mg/day of diamox was a dose for treating (after one develops symptoms) severe altitude sickness, rather than preventing the occurence of AMS (acute mountain sickness). He thought we should be taking about half of this dose.

Although the paresthesias (numbness, tingling of extremeties) caused by diamox aren't considered serious (ie life threatening), they did eventually get bad enough for Jen and Ajay, to the point that Jen was having difficulty holding her trekking poles. They both eventually titrated down a bit on the dose and this seemed to help improve the parethesias. Jeremiah and I continued to take the same dose. With the exception of the summit day, none of us had any significant problems with altitude during our climb. On the summit push itself (starting at 15,000 ft- Barufu Camp), Jen and Ajay definitely felt the effects of AMS. It's impossible to tell whether this was due to the fact that they backed off their dosage of diamox; more than likely it was coincidental...I think any of us could have potentially ended up with more severe altitude illness... it's just the way the cards were dealt.

In addition to diamox, we took daily gingko as well (120mg). There have been case reports suggesting benefit of gingko in altitude acclimatization, but I think most of this is still heresay at this point. Our feeling was it couldn't hurt and we all could use a little improvement in our memory.

We brought along dexamethasone, and nifedipine as well for treatment of possible HAPE (High Altitude Pulmonary Edema) and HACE (High Altitude Cerebral Edema), but fortunately this was not needed (see New England Journal of Medicine article below).

My hypothesis as to why we all did so well in terms of avoiding altitude sickness for the most part, is that we took our time ("pole, pole"), and just soaked in the trip every second and every step that we were on the mountain. Altitude, not fitness, is by and far the biggest reason people fail to summit Kilimanjaro. And the best way to avoid the effects of altitude is to ascend as slowly as possible... the human body can adapt if given a chance.

Although there's lots of good medical literature about altitude illness out there (check www.pubmed.gov and search "altitude illness and review" some of most useful articles that I found were:

West, JB, et al in Annals of Internal Medicine, 2003. One of the best reviews on the pathophysiology of altitude illness (http://www.annals.org/cgi/reprint/141/10/789)

Barry, PW, et al. British Medical Journal, 2003. A good clinical review. http://bmj.bmjjournals.com/cgi/content/full/326/7395/915

Hackett, PH, et al. New England Medical Journal, 2001. Although it's a bit old, its a classic, and not much has changed in our thinking about AMS anyway. This article's got it all: clinical signs and symptoms, diagnosis and treatment, pathophysiology. The one article to read before heading up into thinner air. http://content.nejm.org/cgi/content/extract/345/2/107

One of many cool websites: High Altitude Medicine Guide.

I'm starting to sound a bit like an Amazon Book review.