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ORIGINAL RESEARCH PAPER
A STUDY ON AMS SCORING AND OXYGEN SATURATION (SPO2) OF AMARNATH
YATRIS AT THE AMARNATH HOLY CAVE
Dr. Rajendra
Kumar
Assistant Professor, Department of Physiology, Narayan Medical College & Hospital,
Jamuhar, Sasaram, Bihar, India
Dr. Ashok Kumar
Deo*
Professor and Head , Department of Physiology, Narayan Medical College & Hospita,l
Jamuhar, Sasaram, Bihar, India *Corresponding Author
ABSTRACT
Introduction: With increasing altitude, atmospheric pressure decreases while the percentage of oxygen in air remains constant that is about 21%
and thus the partial pressure of oxygen decreases with altitude. Many Amarnath Yatris can ascend to 5000 to 6500 ft in one day without problems,
but about 40% of those who ascend to 8000 ft and 80% of those who ascend to 10,000 ft develop AMS. The present study was designed with the aim
to assess and correlate with AMS Scoring to oxygen saturation of Amarnath Yatris at the holy Amarnath cave.
Material and Methods: A total of 55 subjects of both male and female of five different age groups were taken. An informed consent was taken from
each subject before the correlational study. Peripheral oxygen saturation (SpO ) was measured with pulse oximetry while AMS Scoring of
2
Amarnath pilgrims were done with Lake Louise AMS Scoring system.
Result: There was a significant decrease in Peripheral oxygen saturation (SpO ) as compared to control as well as AMS Scores was increased.
2
Conclusion: In this study there was a significant decrease in Peripheral oxygen saturation (SpO ) and increase in AMS Scores. Acute Mountain
2
Sickness was present in all the subjects at the height of Amarnath cave and this was related with decrease in Peripheral oxygen saturation (SpO ).
2
KEYWORDS
Peripheral oxygen saturation (SpO2), Amarnath pilgrims, acute mountain sickness (AMS), high altitude.
Lacs of Hindu devotees undergo an annual pilgrimage to the Amarnath
cave across adverse cold hypobaric condition. During ascent for
Amarnath Yatra in the mountains they experience multiple stresses like
co ld t emp er atu re , oxy ge n defi ci enc y, sa ni tat io n pro bl ems ,
dehydration, severe exertion, but the stress unique to high altitudes is
the oxygen-deficient atmosphere. Oxygen saturation is the fraction of
oxygen saturated hemoglobin relative to total hemoglobin in the blood.
The present study was designed with the aim to assess AMS Scores
oxygen saturation of Amarnath Yatris at the holy Amarnath cave. Acute
mountain sickness (AMS) is the commonest form of high altitude
illness which is typically occurs in unacclimatized Amarnath Yatris
ascending to altitudes more than 8000 ft, although it can be seen at
lower altitudes in highly susceptible individuals. Lake Louise AMS
score has provided a important tool for researchers to diagnose and to
score the severity of AMS. With increasing altitude, atmospheric
pressure decreases while the percentage of oxygen in air remains
constant that is about 21% and thus the partial pressure of oxygen
decreases with altitude. Many Amarnath Yatris can ascend to 5000 to
6500 ft in one day without problems, but about 40% of those who
ascend to 8000 ft and 80% of those who ascend to 10,000 ft develop
AMS. Rate of ascent, maximum altitude reached, and sleeping altitude
leads to development of these disorders. Altitude sickness, the mildest
form being acute mountain sickness (AMS), is caused by rapid
.[1]
exposure to hypoxia at high altitude Acute mountain sickness, may
present with a variety of symptoms like headache, loss of appetite
insomnia, and nausea. However, in case of severe AMS confusion,
difficulty walking, progressive cough, shortness of breath, and even
[2]
death were seen in Amarnath Yatris. Ascending slowly is the best
way to avoid acute mountain sickness. Avoiding strenuous activity in
the first 24 hours at high altitude reduces the symptoms of AMS. Fatty
diets and sleeping pills or respiratory depressants slow down the
acclimatization process and should be avoided. A fatty diet tends to
cause diarrhea and exacerbates AMS. Thus, avoiding Fatty diets and
sleeping pills consumption in the first 24–48 hours at a high altitude is
.[3]
optimal Due to lack of oxygen at Amarnath cave R.Q. of Amarnath
Yatris gets deranged resulting in gastrointestinal problems like
Ind ig es tion of fo od , dia rr hea, vo miting and p ai n a bd om en.
Acclimatization is the process of adjusting Amarnath Yatris to combat
hypoxia at higher elevations, in order to avoid acute mountain sickness
[4]. Approximately at 10,000 ft Amarnath Yatris should take the "climb-
hig h, sleep- low" a pproach. Fo r Ama rnath pilgr ims a typical
acclimatization regimen should be to stay a few days at a lower base
camp for Yatris then climb up to a higher camp slowly and then return
to base camp for night stay. A subsequent climb to the higher altitude
then includes an overnight stay at lower base camp for Amarnath
pilgrims. This process is then repeated a few times, each time
extending the time spent at higher altitudes to let the body adjust to the
oxygen level there, a process that involves the production of more
RBCs. Once the Amarnath pilgrims have acclimatized to a given
altitude, the process is repeated with camps placed at progressively
higher elevations. The rule of thumb is to ascend no more than 1,000 ft
per day to sleep. That is, one can climb from 9,800 ft to 15,000 ft in one
day, but one should then descend back to 10,800 ft to sleep. This
process cannot safely be rushed, and this is why Amarnath pilgrims
need to spend days acclimatizing before climbing a high peak.
Am arn ath p ilg rim s sho uld d es igned t o all ow p artia l pre -
acclimatization to high altitude, reducing the total time required on the
.[5]
mountain itself In most of the Amarnath Yatris dehydration was
present probably due to the increased rate of water vapor lost from the
lungs at higher Amarnath holy cave. This might be contribute to the
[6]
symptoms of acute mountain sickness in Amarnath pilgrims. The
rapid ascent, altitude attained, amount of physical activity at high
altitude, as well as individual susceptibility, were contributing factors
to the onset and severity of high-altitude illness. High AMS scores
were observed in almost all the Amarnath Yatris usually due to rapid
ascent and could usually be prevented by ascending slowly. In most [7]
of these cases, the symptoms were temporary and usually prevented
with as altitude acclimatization.
MATERIAL AND METHODS:
The study was conducted in the department of physiology and
Amarnath cave located in Jammu Kashmir, India in July 2014. This
study was approved by the Ethical Committees of the institution, and
written informed consents were obtained from all the Amarnath Yatris
whom were agreed for study. A total of 55 subjects from Amarnath
Yatris of both male and female of different age groups were chosen for
this study. Diagnosis of AMS was based on the AMS Score and a rise in
altitude within the last 4 days. Mild AMS were diagnosed when total
AMS Score was 3–5 , moderate AMS Score was 6–9, and severe AMS
on 10– 12 Score points. Although symptoms can develop within 6
hours of increase in altitude, we take for assessing AMS score only
after 6 hours, to avoid confusing AMS with confounding symptoms
from travel or responses to acute hypoxia.
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
Physiology
International Journal of Scientific Research
73
Volume-8 | Issue-10 | October - 2019 | PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr
Lake Louise AMS questionnaire
A Headache
Score
No headache
0
Mild headache
1
Moderate headache
2
Severe headache
3
B Gastrointestinal symptoms
No gastrointestinal symptoms
0
Poor appetite or nausea
1
Moderate nausea or vomiting
2
74
International Journal of Scientific Research
In 2014 approx 372909 Amarnath Yatris had darshan at holy cave. But
due to bad weather and adverse condition our study was limited to 55
Yatri s o nly. Pu ls e o xi meter and Lak e L ouise AMS Sc or ing
questionnaire was used for this study and method was pulse oximetry.
Oxygen saturation (SpO ) was measured by pulse oximetry which
2
works by emitting and then absorbing a light wave passing through
capillaries in the fingertip. AMS scoring was done with asking Lake
Louise AMS Scoring questionnaire two times on 2hr intervals at the
height of Holy cave (12756 ft).
RESULT:
There was a significant decrease in Peripheral oxygen saturation
(SpO ) as compared to control value as well as AMS Scores was
2
increased at the height of holy cave (12756 ft). Control value for
oxygen saturation was 98% and for AMS Score it was 0. Mean SpO of
2
Amarnath Yatris was 74.98 with S.D. of 11.0 at the altitude of 12756 ft.
Mean AMS Score of Amarnath Yatris was 6.0 with S.D. of 1.5. AMS
Scoring showed moderate acute mountain sickness (AMS). We found
that acute mountain sickness (AMS) was related with decreased
oxygen saturation. However some other causes may be associated for
the mountain sickness. But our study found that AMS was associated
with decreasing oxygen saturation in Amarnath Yatris during yatra.
Figure 1 showing Mean SpO of Amarnath Yatris 74.98 with S.D. of
2
11.0 at the Holy cave
Figure 2 showing Mean AMS Score of Amarnath Yatris 6.0 with
S.D. of 1.5 at the Holy cave
Minimum AMS Score was 4 which mean in all the subjects mild AMS
were observed. Maximum score was 12 which reflect severe AMS.
However mild to moderate AMS were seen in all the pilgrims at the
holy Amarnath cave. In our study we found that above 55 years aged
pilgrims developed AMS more than younger age groups. It was 6.9 in
comparison to 5.6 in 15-24 years age groups. Rise in AMS Score and
fall in oxygen saturation was similar in females like that of males.
Table showing mean SpO and AMS score of 5 age groups of
2
Amarnath Yatris at the holy cave (12756 ft)
Rise in AMS score was not parallel to decrease in SpO but there was
2
some association between these two.
CONCLUSION:
In this study there was a significant decrease in Peripheral oxygen
saturation (SpO ) and increase in AMS Scores. Acute Mountain
2
Sickness was present in all the subjects at the height of Amarnath cave
and this was related with decrease in Peripheral oxygen saturation
(SpO ).
2
REFERENCES :
1 Altitude Diseases Injuries- poisoning Merk Manuals 2018 3rd edition.
2 Simancas-Racines, D; Arevalo-Rodriguez, I; Osorio, D; Franco, JV; Xu, Y; Hidalgo, R
(30 June 2018). "Interventions for treating acute high altitude illness". The Cochrane
Database of Systematic Reviews. 6: CD009567. doi: 10.1002/14651858.CD009567.
pub2. PMID 29959871
3 A. A. R. Thompson. Altitude Sickness. Apex. Retrieved 8 May 2007
4 Muza, S.R.; Fulco, C.S.; Cymerman, A. (2004). "Altitude Acclimatization Guide". U.S.
Army Research Inst. Of Environmental Medicine Thermal and Mountain Medicine
Division Technical Report (USARIEM–TN–04–05). Retrieved 5 March 2009.
5 Tortora, Gerard J; Anagnostakos, Nicholas P.(1987). Principles of anatomy and
physiology (Fifth ed.). New York: Harper & Row, Publishers. pp. 444–445. ISBN 978-0-
06-350729-6.
6 Hackett, P H; R C Roach (12 July 2001). High-altitude illness. The New England Journal
of Medicine. 345 (2): 107–114
7 A. A. R. Thompson. Altitude Sickness. Apex. Retrieved 8 May 2007
PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsrVolume-8 | Issue-10 | October - 2019
15 – 24yrs
SpO
2
AMS
25 – 34yrs
SpO
2
AMS
35 – 44yrs
SpO
2
AMS
45 – 54yrs
SpO
2
AMS
55yrs –
ABOVE
SpO AMS
2
75.9±
4.78
5.6
79±3.
92
5.0
74.5±4.9
2
5.9
75.6±
3.58
06
69.8±23
.54
6.9
Severe nausea & vomiting
3
C Fatigue and/or weakness
Not tired or weak
0
Mild fatigue/weakness
1
Moderate fatigue/weakness
2
Severe fatigue/weakness
3
D Dizziness
Not dizzy
0
Mild dizziness
1
Moderate dizziness
2
Severe dizziness
3
E Difficulty sleeping
Slept
0
Did not sleep as well as usual
1
Woke many times, poor night's sleep
2
Could not sleep at all
3
Total score
0 - 15