title: High altitude illness in pilgrims after rapid ascent to 4380 M.
abstract: BACKGROUND
  The goal of the study was to characterize high altitude illness in Nepali pilgrims.
  
  
  METHODS
  We kept standardized records at the Himalayan Rescue Association (HRA) Temporary Health Camp at Gosainkund Lake (4380 m) in the Nepal Himalaya during the annual Janai Purnima Festival in 2014. Records included rate of ascent and Lake Louise Score (LLS). We defined High Altitude Headache (HAH) as headache alone or LLS = 2. Acute Mountain Sickness (AMS) was LLS≥3. High Altitude Cerebral Edema (HACE) was AMS with ataxia or altered mental status.
  
  
  RESULTS
  An estimated 10,000 pilgrims ascended rapidly, most in 1-2 days, from Dhunche (1960 m) to Gosainkund Lake (4380 m). We saw 769 patients, of whom 86 had HAH. There were 226 patients with AMS, including 11 patients with HACE. We treated patients with HACE using dexamethasone and supplemental oxygen prior to rapid descent. Each patient with HACE descended carried by a porter. There were no fatalities due to HACE. There were no cases of High Altitude Pulmonary Edema (HAPE).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA, USA; Himalayan Rescue Association, Kathmandu, Nepal. Electronic address: kenzafren@gmail.com.
authors.forename: Ken
authors.initials: K
authors.lastname: Zafren
authors.affiliation: Mountain Medicine Society of Nepal, Kathmandu, Nepal.
authors.forename: Matiram
authors.initials: M
authors.lastname: Pun
authors.affiliation: Mountain Medicine Society of Nepal, Kathmandu, Nepal.
authors.forename: Nirajan
authors.initials: N
authors.lastname: Regmi
authors.affiliation: Himalayan Rescue Association, Kathmandu, Nepal.
authors.forename: Gobinda
authors.initials: G
authors.lastname: Bashyal
authors.affiliation: Himalayan Rescue Association, Kathmandu, Nepal.
authors.forename: Bhuwan
authors.initials: B
authors.lastname: Acharya
authors.affiliation: Mountain Medicine Society of Nepal, Kathmandu, Nepal.
authors.forename: Subarna
authors.initials: S
authors.lastname: Gautam
authors.affiliation: Mountain Medicine Society of Nepal, Kathmandu, Nepal.
authors.forename: Sujan
authors.initials: S
authors.lastname: Jamarkattel
authors.affiliation: Mountain Medicine Society of Nepal, Kathmandu, Nepal.
authors.forename: Shankar Raj
authors.initials: SR
authors.lastname: Lamichhane
authors.affiliation: Mountain Medicine Society of Nepal, Kathmandu, Nepal.
authors.forename: Suman
authors.initials: S
authors.lastname: Acharya
authors.affiliation: Oxford University Clinical Research Unit-Nepal, Kathmandu, Nepal; Himalayan Rescue Association, Kathmandu, Nepal.
authors.forename: Buddha
authors.initials: B
authors.lastname: Basnyat
mesh_terms: D000208:Acute Disease; D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D001929:Brain Edema; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006693:Holidays; D006801:Humans; D008297:Male; D009390:Nepal; D010100:Oxygen / Q000627:therapeutic use
chemical_list: D003907:Dexamethasone; D010100:Oxygen
keywords: Acute mountain sickness; Altitude sickness; High altitude cerebral edema; High altitude pulmonary edema; Hypoxia; Pilgrims