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Ghost sickness — Clinical Guidelines

Overview

Ghost sickness, often associated with high-altitude exposure, encompasses symptoms resembling acute mountain sickness (AMS) and may include severe physiological disturbances such as intravascular hemolysis 9. It primarily affects individuals ascending rapidly to high altitudes without adequate acclimatization.

Diagnosis

Symptom Assessment: Includes headache, nausea, fatigue, dizziness, and potentially more severe symptoms like intravascular hemolysis 9.

Altitude Monitoring: Essential to correlate symptoms with altitude exposure 8.

Clinical Evaluation: Physical examination to rule out other conditions 5.

Management

Acetazolamide: Effective in preventing AMS; dosage specifics not detailed but shown to improve summit rates 8.

Spironolactone: Prophylactic use at altitudes above 3,000 m; 25 mg three times daily for two days before and during exposure 10.

Gradual Ascent: Recommended to minimize symptoms and improve acclimatization 11.

Special Populations

Trekking Groups: Historical evidence suggests prophylactic spironolactone can prevent AMS in adults 10.

Athletes: Performance may be affected by AMS; optimal acclimatization period suggested to be 2-3 days 11.

Key Recommendations

Use Acetazolamide for Prevention: Consider acetazolamide for preventing AMS in high-altitude ascents (Evidence: Moderate 8).

Implement Gradual Ascent Strategies: Gradual ascent helps in minimizing AMS symptoms (Evidence: Expert opinion 11).

Consider Spironolactone Prophylaxis: For groups trekking at high altitudes, spironolactone may prevent AMS effectively (Evidence: Weak 10).

References

1 Harley JM, Hin-Hei Lau C, Bilgic E, Moran RM, Fried GM, Bhanji F. Identifying Royal College-accredited simulation centre research priorities across Canada. Canadian medical education journal 2023. link 2 Gasser B, Stouder J. Rescue Emergencies Due to High-Altitude Illnesses Are Rare in Switzerland. International journal of environmental research and public health 2022. link 3 Hayden EM, Khatri A, Kelly HR, Yager PH, Salazar GM. Mannequin-based Telesimulation: Increasing Access to Simulation-based Education. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2018. link 4 Bowe SN, Johnson K, Puscas L. Facilitation and Debriefing in Simulation Education. Otolaryngologic clinics of North America 2017. link 5 Milledge JS. Stanhope Speer, Physician and Alpinist: In 1853, First to Describe Mountain Sickness?. High altitude medicine & biology 2015. link 6 Lighthall GK, Harrison TK. A controllable patient monitor for classroom video projectors. Simulation in healthcare : journal of the Society for Simulation in Healthcare 2010. link 7 Kurrek MM, Devitt JH. The cost for construction and operation of a simulation centre. Canadian journal of anaesthesia = Journal canadien d'anesthesie 1997. link 8 Greene MK, Kerr AM, McIntosh IB, Prescott RJ. Acetazolamide in prevention of acute mountain sickness: a double-blind controlled cross-over study. British medical journal (Clinical research ed.) 1981. link 9 Lovlin RE, Rowlands S, Kinnear GR, Rast E. Intravascular hemolysis in acute mountain sickness. Aviation, space, and environmental medicine 1980. link 10 Currie TT, Carter PH, Champion WL, Fong G, Francis JK, McDonald IH et al.. Spironolactone and acute mountain sickness. The Medical journal of Australia 1976. link 11 Shephard RJ. The athlete at high altitude. Canadian Medical Association journal 1973. link

Ghost sickness