M. V. Singh

Amelioration of acute mountain sickness: Comparative study of acetazolamide and spironolactone

Acetazolamide and spironolactone were evaluated for their ameliorating effects on acute mountain sickness (AMS). Studies were conducted in 29 healthy male subjects in lowland and at a height of 3,500 m after their airlift. A modified General High Altitude Questionnaire (GHAQ) was used to evaluate the effectiveness of these drugs for reducing the intensity of AMS symptoms. Both the drugs were found to be helpful in minimising the occurrence as well as severity of most of the symptoms. Spironolactone seems to be a superior prophylactic agent than acetazolamide.

Body fluid status on induction, reinduction and prolonged stay at high altitude of human volunteers.

Studies on adaptation to high altitude (HA) of 3500 m in the Himalayas were conducted in three phases, each including 10 normal and healthy males normally resident at sea-level. Phase I subjects had no previous experience of HA, phase II subjects after 4–6 months at HA were airlifted to sea-level and phase III subjects stayed continuously for 6 months at 3500 m. Body fluid compartments and blood gases were determined in all three groups. Plasma volume was highly elevated in the phase II subjects on reinduction to sea-level from HA. In comparison to phase I subjects, the retention of fluid in extracellular compartment was increased at HA leading to increased susceptibility to high altitude illness. Phase III subjects were hyperhydrated with decreased plasma volume and increased PO2 in comparison to the other two groups.

Effect of yogic exercises on thyroid function in subjects resident at sea level upon exposure to high altitude

Using radioactive iodine, the effect of 1 months yogic exercises has been investigated on the thyroid function of subjects resident at sea level (SL) specially after their exposure to high altitude (HA). The results have been compared with a group of SL subjects who underwent physical training (PT) exercises for the same duration. Ten healthy male volunteers in the age range of 20–30 years were used as test subjects in this study with each serving as his own control. The subjects were randomly divided into two groups of 5 each. One group practised hatha yogic exercises, while the other group performed the regular PT exercises. The thyroidal accumulation and release of radioactive iodine have been measured in each of the subjects of both groups before and after 1 month of their respective exercises at SL. One month of yogic exercises at SL has been observed to cause a significant reduction in the trans-thy-roidal availability of radioiodine. The thyroid radioactivity in this group of subjects was always below normal levels with the exception of two peaks of radioactive iodine uptake, when the levels of radioactivity in the thyroid were similar to the control values of pre-yogic exercises. The release of radiolabel at 24–48 h was significantly increased after yogic exercises. In contrast, the subjects performing PT exercises for the same duration at SL showed significant thyroid uptake of radioactive iodine at 24 h. Subsequently their131I uptake continued to rise slowly until 72 h without any demonstrable thyroidal release of radiolabel. This indicated that increased thyroid activity was induced by conventional PT exercise. Exposure of SL residents to HA irrespective of their exercise regime altered the thyroidal handling of radioiodine. Thyroidal concentrations of freshly administered radioiodine at early and late sampling intervals were very high in both of the groups, especially the yogics, after their return to SL from HA. Possible mechanisms of the observed changes have been discussed.

Hydration and tissue solid content of the lean body on prolonged exposure to altitude.

Using densitometric, hydrometric and anthropometric techniques, body fat, tissue solids, water and mineral content were quantitatively measured on two groups each of 26 young and healthy Indian soldiers of mixed ethnic composition. The experimental group was exposed to 3500 m altitude for 2 years and the experiments were carried out after 48 h and 3 weeks rehabilitation in Delhi (300 m). The control group was never exposed to high altidues. Inspite of the experimental group being fed with superior rations at high altitude, this group showed significantly hyperhydrated lean body with reduced tissue solids in comparison to the control group which was fed with identical rations in Delhi. The calculated mean density of the fat free body had declined to 0.092×103 kg/m3. The 3 week stay at low altitude had little influence on body composition. Hyperhydration, with reduced tissue solids, would cause reduction in the density of fat free body, and would thus interfere with the estimates of total body fat based on densitometric procedures alone. In the hyperhydrated state, Siris formula overestimated fat by 22.8% of the true value.

Changes in body fluid compartments on re-induction to high altitude and effect of diuretics*

Studies were carried out in 29 healthy young adults in the Indian Army stationed in the plains and posted at an elevation of 3500 m for more than 6 months. After exposure to a low elevation in Delhi (260 m) for 3 weeks they were reinduced to a height of 3500 m. The subjects were divided into three groups, each of which was treated with either placebo or acetazolamide or spironolactone. The drug treatment was started immediately after their landing at high altitude and continued for 2 days only. Total body water, extracellular fluid, intracellular fluid, plasma volume, blood pH, PaO2, PaCO2 and blood viscosity were determined on exposure at Delhi and on re-induction to high altitude. Plasma volume was increased after the descent from high altitude and remained high for up to 21 days study. This increased plasma volume may have some significance in the pathogenesis of pulmonary oedema. Total body water and intracellular fluid content were increased at 260 m elevation, while extracellular fluid decreased. On re-induction there was a decrease in total body water with no change in the extracellular fluid content.

Thyroidal handling of radioiodine in sea level residents exposed to hypobaric hypoxia

In the present investigation thyroidal accumulation of radioiodine and its release were assessed by direct testing of thyroid function using radioactive iodine, in vivo, in sea level residents intermittently exposed to hypobaric hypoxia. Thyroidal accumulation of radioiodine and its turnover were examined daily for 14 days. Twelve healthy human male volunteers were divided into three groups, with an equal number of individuals in each group. A decompression chamber was used to expose each group of subjects to hypoxic conditions at a simulated altitude of 3810 m for 8 h/day for 14 days. An oral dose of 25μCi iodine-131 was administered to each individual of the first group immediately before the initiation of intermittent hypoxia. The second group of subjects received a tracer dose at the beginning of the 4th day of the 14 days, intermittent exposure to hypoxia, while the third group received the tracer dose 1 week after the completion of the exposure. Control studies were carried out on the subjects before they were subjected to the experimental conditions. Thyroidal accumulation of131I in experimental subjects during the hypoxic state and in the post-hypoxic state was higher than in the control studies. The pattern of accumulation during exposure to hypoxia and in the post-hypoxic state showed multiple peaks of radioactive iodine uptake (PRAIU), a unique feature. The multiple PRAIU by the thyroid in experimental subjects were sharp and of short duration, reflecting an increased rate of13I release from the thyroid. Control subjects had a single PRAIU by the thyroid 24 h after the administration of tracer.

Changes in plasma volume during hypohydration and rehydration in subjects from the tropics

SummaryPlasma volume (PV) at different levels of hypohydration was determined using radio-iodinated serum albumin-125 in 28 heat acclimated male volunteers in hot dry conditions in a climatic chamber. The heat acclimated subjects were hypohydrated to varying degrees i.e. 1%, 2%, 3% and 4% body mass deficit by moderate work in hot conditions in a climatic chamber maintained at 45°C dry bulb temperature and 30% relative humidity. A rehydration study was carried out in only those subjects who were hypohydrated to 3% and 4% body mass and they were brought back to a 2% level of hypohydration by giving a calculated amount of water. A significant decrease in PV was observed at 3% and 4% hypohydration only. The magnitude of the decrease was the same in both the groups and not related to the level of hypohydration. With partial rehydration in the 3% hypohydrated group PV was restored fully, while in the 4% hypohydrated group restoration was incomplete, indicating that at this hypohydration level some of the replenished water that entered in plasma may have moved to the intracellular compartment which may have contributed more at 4% hypohydration. It is suggested that with higher levels of thermal hypohydration significant reduction in the intracellular compartment may result in accentuated physiological strain during work in the heat.

The effects of acetazolamide and spironolactone on the body water distribution of rabbits during acute exposure to simulated altitude

The role of body water metabolism on acute altitude exposure was studied. The studies were carried out in rabbits divided into four groups, namely, (i) control, (ii) exposed to acute hypoxia, (iii) exposed to acute hypoxia after treatment with 250 mg acetazolamide and (iv) exposed to acute hypoxia after treatment with 25 mg spironolactone. Total body water, extracellular water, intracellular water and blood volume decreased by an insignificant amount on exposure to hypoxia and plasma volume decreased by 5.7% (P<0.025). Treatment with either acetazolamide or spironolactone resulted in further marginal decrease in total body water. In the case of acetazolamide, the loss occurs from both intracellular and extracellular compartments, while treatment with spironolactone resulted in significant loss only from extracellular compartment. Treatment with both the drugs resulted in a small rise in pO2 and pCO2 with a slight decrease in pH. Our data suggested spironolactone to be a better prophylactic agent for use on acute high altitude induction.