15-21 February 2013 #643

The heights of war

Altitude sickness used to be misdiagnosed with pneumonia and treated with antibiotics
Dhanvantari by Buddha Basnyat, MD

More than 50 years ago, Chinese and Indian soldiers found themselves locked in lethal combat at 5,000 metres in the disputed Aksai Chin region of Ladakh. If you’ve watched or read The Hobbit, think about the colossal battle in the Misty Mountains, the 1961-62 Sino-India war was fought in a similarly treacherous terrain.

Unfortunately, many Indian soldiers arrived at Aksai Chin from the Indian plains without proper acclimatisation and suffered life-threatening forms of altitude sickness such as high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE). To make things worse, HAPE and HACE were almost unknown to the medical fraternity in the early 60s and as a result, many soldiers were misdiagnosed with pneumonia and treated with antibiotics.

Later on the doctors came to realise the men were not suffering from pneumonia, but water collected in their lungs was making them sick. The medical team intuitively thought the water was due to the heart’s inability to pump blood efficiently in the cold and low-oxygen environment. 

So they stopped the antibiotics, used digoxin to flog the heart muscles, and prescribed powerful diuretics (like Lasix) for edema. Unfortunately, none of these drugs (antibiotics, digoxin, or diuretics) are useful for HAPE and hundreds of lives were lost in the high mountains.

The Chinese army, on the other hand, was far better prepared than its Indian counterpart to survive at high altitude. With a long history of fighting in the mountains with Tibetans and others, they are experts in alpine warfare. Unlike Indian soldiers many of whom were flown directly from New Delhi to Ladakh in their summer uniforms, the Chinese wore well-padded clothes to prevent hypothermia, were better rested, and did not exert themselves excessively upon arriving at Aksai Chin, a key component in acclimatisation. No surprise then that China eventually won the war.

The tragedy in Ladakh, however, led to some of the most comprehensive research and field literature about altitude sickness. The 1965 article on HAPE by Captain Menon in The New England Journal of Medicine is a classic work, and the study in the same journal in 1969 by General Inder Singh et al of almost 2,000 soldiers fighting in this hostile terrain is clearly a tour de force.

Despite this wealth of knowledge, lack of awareness about altitude illness continues to plague the subcontinent. Last year, over a hundred Indian pilgrims died due to altitude sickness while visiting Sri Amarnath Temple (4000m) in Jammu and Kashmir.

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