Small Sip of Water on the Hemkund Sahib

Todays quick read : a small pilot study on altitude sickness in Sikh pilgrims . Pilgrims progress up the Himalayas in a manner that will make experienced docs shudder , in part from a mindset that invites suffering – to a point. It is the same reality described in Basnyats Disoriented and Ataxic Pilgrims , from Gosaikhund in Nepal , where a large majority of the yatras suffered from AMS.

This small study ( 28 subjects , interviewed at the Hemkund Sahib temple @ 4330 meters ) is fuelled by two concerns : the rapid ascent , and the minimal fluid intake. The authors have set up a info page for coming pilgrims echoing the same concern about the water intake , urging a high water intake not only during but also before trekking up the Hemkund Sahib. Their main source for this is an article by Peter Hackett , mentioning advice handed out by the Himalayan Rescue Association – in 1975 (!) . This advice coming up now will surprise anyone who

* has read what Hackett ( who after extensive work with the HRA summited on Mt Everest as part of a medical research expedition , and now is the head of the Institute for Altitude Medicine in Telluride ) written on the subject afterwards :

..In reality you only need an additional liter to a liter and a half of water at altitude. Too much water is harmful and can dilute your body’s sodium level (hyponatremia) causing weakness, confusion, seizures, and coma.

* has read the advisory from the Himalayan Rescue Association over the last decade :

Maintaining adequate hydration

Adequate amounts of fluid (about 3 liters a day) are necessary in the mountains:- dehydration mimics altitude sickness and may even predispose to it. On the other hand excessive water drinking should also be avoided as this may lead to electrolyte imbalances.

( Also note that right from the start in -75 HRA talks of total fluid intake , not about drinking water : all fluids count , and the only unique value of plain water is a stronger push towards hyponatremia . )

* has read the relevant part of Hacketts first study : the outcome was that all participants lost weight , and that those who had the highest weight loss were the the ones who did not develop AMS :

Weightloss occurred in both groups , but was less in the AMS group (P0.07) . Indeed , the worse or higher the symptom score , the less the weight loss.

The other strong predictor for avoiding AMS was higher urine output. The second source quoted by Sahota and Panwar manages to find support for that . And only that.

Sources mentioned here :

Current acclimatization advice from Himalayan Rescue Association

A Pilot Study on the incidence of Acute Mountain Sickness at the Sikh pilgrimage to Hemkund Sahib

The incidence, importance and prophylaxis of acute mountain sickness – Peter Hackett & Drummond Rennie in The Lancet , 1976

Altitude Myths @ the Institute for Altitude Medicine

Nerin et al : Acute Mountain Sickness : Influence of Fluid Intake

For a non-medicalese version of acclimatization and hydration advice , see this interview with David Shlim , another veteran of the HRA clinic in Pheriche , fifteeen years as head of the CIWEC clinic in Kathmandu, and co-author of the CDC altitude advisory with Hackett.

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