2,11,16 Travel to altitude could have more severe consequences fo

2,11,16 Travel to altitude could have more severe consequences for diabetic patients with complications or poor metabolic control, and they should be evaluated and counseled accordingly. All diabetic patients should be carefully screened for complications that could increase their risk associated with exercise or exposure to altitude.11 The Web site www.mountain-mad.org is an excellent resource for people with diabetes who are interested in mountain pursuits.84 Ri-Li and colleagues found that obese people had worse AMS scores than non-obese counterparts

at a simulated altitude of 3,658 m.85 This effect is attributed to nocturnal desaturation associated with periodic, apneic breathing.85,86 Furthermore, excess abdominal weight increases the likelihood of OSA and obesity–hypoventilation Sirolimus in vitro syndrome.8 These factors can exacerbate both hypoxemia and pulmonary hypertension which may increase an individual’s risk for

developing HAPE.8,43 Excess body weight may also complicate or preclude stretcher rescue from remote locations. Obesity–hypoventilation syndrome is a contraindication to high altitude travel. If such travel is necessary, supplemental oxygen and prophylactic acetazolamide are recommended.8 The effect of altitude on the seizure threshold has not been studied in depth. However, many well-controlled epileptics safely travel to altitude and are at no known increased risk the for development of altitude-related illness or seizures.43,87 Palbociclib clinical trial There have been multiple case reports of seizures occurring in non-epileptic individuals at altitude, including one fatal case.12,87–91 Daleau and colleagues reported a case where previously undiagnosed hyperventilation-induced

seizures were unmasked in a patient with a positive family history for epilepsy.92 Basnyat also reported a single case of grand mal seizures at high altitude in a well-controlled epileptic patient on anticonvulsant medications.87 Seizures at high altitude are believed to be provoked by a number of potential factors including respiratory alkalosis, hypocapnia, hypoxia, or sleep deprivation.12,87 Fluoroquinolone antibiotics prescribed for gastroenteritis have also been implicated in two case reports87,88 because of their potential for lowering the seizure threshold.93 Lastly, although the potential for having a seizure may not be greatly elevated at altitude, consideration must be given to the additional potential for harm, should a seizure occur in a remote location or while performing high risk technical mountaineering maneuvers. The risk of stroke at altitude may be increased due to hyperviscosity secondary to polycythemia, dehydration, cold exposure, and forced inactivity. Ischemic stroke and cerebral artery thrombosis are potential complications of high altitude cerebral edema.

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