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14er newbie - frequent urination while hiking, AMS??

FAQ and threads for those just starting to hike the Colorado 14ers.
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Re: 14er newbie - frequent urination while hiking, AMS??

Postby MountainMedic » Thu Sep 20, 2012 4:08 pm

gkblackwyo wrote:
MountainMedic wrote:I love that people keep trying to find another reason for these symptoms. It was AMS. You ascended to high altitude and shortly thereafter exhibited a throbbing diffuse headache, polyuria, and nausea. Textbook. In the absence of a significant previous medical history, you won't find a doctor who tells you otherwise. I'm not saying dehydration couldn't have played a role, but your medical diagnosis was AMS.

I don't care if you were cold, or have a small bladder, or were dehydrated (well, I do, I don't want you to have to worry about any of that). Even if that's all true, you still had AMS. Keep training at altitude and with any luck you won't get it again!



Actually, with AMS urine output decreases.


Urine output is increased as part of acclimatization as well as in mild AMS. It decreases in moderate to severe AMS (Auerbach, 6th Ed. of "Wilderness Medicine." This book is my bible).

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby wildlobo71 » Thu Sep 20, 2012 4:08 pm

climbingaggie03 wrote:HAFE High Altitude Flatus Expulsion http://en.wikipedia.org/wiki/High_altitude_flatus_expulsion it's on wikipedia, it must be true.


Did any of you read the Western Journal of Medicine submittal citation? My favorite line:

"This phenomenon was most recently witnessed by us during an expedition in the San Juan Mountains or southwestern Colorado, with similar experiences during excursions past. The syndrome is strictly associated with ascent, and is characterized by an increase in both the volume and the frequency of the passage of flatus, which spontaneously occurs while climbing to altitudes of 11,000 feet or greater. The eructations (known to veteran backpackers as "Rocky Mountain Barking Spiders") do not appear to vary with exercise, but may well be closely linked to diet."
Bill W.
Yes, I have my Scotch.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby MountainMedic » Thu Sep 20, 2012 4:11 pm

djkest wrote:
peter303 wrote:[-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X [-X

djkest wrote:You might also try some ibuprofen when you are nearing the summit on the way up. It can help alleviate symptoms of AMS (although it does not prevent AMS in any way).


Very dangerous medical advice. Dehydration and iproprofen can terminate your kidneys.
http://articles.latimes.com/2011/feb/14/health/la-he-0214-painkillers-backfire-20110214
http://voices.yahoo.com/an-important-warning-pain-relievers-kidney-5793882.html


Funny because I asked a very intelligent Medical Doctor who did some research and concurred that taking ibuprofen prophylactically was acceptable for this use. I never said to take ibuprofen and become dehydrated.

This HAS been discussed on 14ers.com before to great lengths...


Ibuprofen is totally acceptable as prophylaxis, although it's not particularly effective. Acetazolamide is the best option, followed by acetominophen (Tylenol). Ibuprofen may help, but not as much. Whoever said the person taking it was dehydrated? Not only is taking ibuprofen while dehydrated bad - being dehydrated is also bad. Who knew?

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby sunny1 » Thu Sep 20, 2012 4:17 pm

Kevo wrote:

Less atmospheric pressure at altitude allows stomach gasses to expand. Expanding gas needs a place to go, so....

Milan wrote:

I've been thinking about that but less preasure is not enough to cause so much of it. If we assume that the gas behaves as an ideal gas, then its behavior is described by this equation:
pV=nRT
p is pressure (in pascals, not PSI), V is volume (in m^3, not cubic inches, feet nor miles), n is amount (in moles, unit new enough that nobody was able to screw up yet), R is a constant and T is temperature (Kelvin, not Fahrenheit nor celsius)....
All n, R and T are constants (assume now no additional gas forming and body temperature is constant) and preasure changes from 83 000 Pa in Denver to 61 000 Pa on a 14er, which means volume increases 83 000/61 000 which is 1.36 times. So from 1 gallon of the gas in Denver, you have just 1.36 galon of gas on the summit of a 14er. In my opinion, not enough.
:lol:

I am typing on an outdated computer with outdated capabilities, so pardon the lack of finesse with quoting.

I'm with Kevo on this one, Milan. You get style points for a very clever and humorous calculation! =D> :bow:

Think about what happens when you open a yogurt container in Denver that was filled at lower elevation: It's under pressure. It explodes! SPLAT!

Now think about what happens to your shampoo bottle when you travel from Denver to sea level: it's sucked in.

Now extrapolate to hiking 14ers - when do you get the most gas? En route to the summit, on the summit or on the descent (you don't have to answer this publicly!) :lol:
The older you get, the better you get, unless you're a banana.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby MountainMedic » Thu Sep 20, 2012 4:31 pm

MountainMedic wrote:
gkblackwyo wrote:
MountainMedic wrote:I love that people keep trying to find another reason for these symptoms. It was AMS. You ascended to high altitude and shortly thereafter exhibited a throbbing diffuse headache, polyuria, and nausea. Textbook. In the absence of a significant previous medical history, you won't find a doctor who tells you otherwise. I'm not saying dehydration couldn't have played a role, but your medical diagnosis was AMS.

I don't care if you were cold, or have a small bladder, or were dehydrated (well, I do, I don't want you to have to worry about any of that). Even if that's all true, you still had AMS. Keep training at altitude and with any luck you won't get it again!



Actually, with AMS urine output decreases.


Urine output is increased as part of acclimatization as well as in mild AMS. It decreases in moderate to severe AMS (Auerbach, 6th Ed. of "Wilderness Medicine." This book is my bible).


Curious about what you said so I did a little more research. Found a couple conflicting reports, but I think the general consensus is that you're right - urine output decreases pretty quickly in AMS. I suppose the question is where you define the line between acclimatizing and AMS. Urine output DOES increase with adjustment to altitude - but when in the AMS spectrum does it start to decrease? At this point we're talking semantics. Nonetheless, with increased urine output (if not considered a a sign of mild AMS, certainly one of acclimatization), high altitude headache, and nausea, I'm sticking with - guess - AMS! I am curious if the original poster experienced a relief in the constant urination once the headache and nausea started. If so, a strong pointer towards your statement (with a sample size of one, unfortunately).

Sorry for essentially dismissing your comment initially. You a fellow medical man?

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby milan » Thu Sep 20, 2012 4:42 pm

All right Sunny, more gas may be dissolved in ... well, you know.... then, like soda... or like natural gas in oil..... hmhm, I don't know how to calculate this :roll:


And yes, I may answer publicly, pretty much all the time.. and second day.. and third ... however, there were trips where it didn't happend, weird...

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby gkblackwyo » Thu Sep 20, 2012 4:56 pm

Curious about what you said so I did a little more research. Found a couple conflicting reports, but I think the general consensus is that you're right - urine output decreases pretty quickly in AMS. I suppose the question is where you define the line between acclimatizing and AMS. Urine output DOES increase with adjustment to altitude - but when in the AMS spectrum does it start to decrease? At this point we're talking semantics. Nonetheless, with increased urine output (if not considered a a sign of mild AMS, certainly one of acclimatization), high altitude headache, and nausea, I'm sticking with - guess - AMS! I am curious if the original poster experienced a relief in the constant urination once the headache and nausea started. If so, a strong pointer towards your statement (with a sample size of one, unfortunately).

Sorry for essentially dismissing your comment initially. You a fellow medical man?[/quote]

Hey, No apologies! I'm all about physiology quandaries and never assume I've got anything completely right, lol! I'm not officially medical, but I have a degree in physiology and am now completing my RN=)

I hadn't seen anything about initial increases of urine output with AMS, but I was not looking at quality resources--your book sounds awesome though and I'll have to check a copy out sometime! My thinking is this: altitude causes swelling, which if the fluid's moving to the periphery there's less to pee out. However, swelling is caused by higher blood pressure (elevated by both high altitude and exercising). In addition to swelling, elevated BP increases kidney filtration and.........urine output!! So, my guess is you're right=)

My main thought against AMS was not so much related to her urine output but that she had no complaints of fatigue--which in my personal experience and I've read on sites is a common symptom.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby madbuck » Thu Sep 20, 2012 5:03 pm

MountainMedic wrote:I love that people keep trying to find another reason for these symptoms. It was AMS.


Agreed: horses, not zebras.

gkblackwyo wrote:Actually, with AMS urine output decreases.


I take it as polyuria going up as part of the acclimatization, and then headaches from mild AMS, suggesting lack of acclimatization and/or unfortunate genetics or a "bad day" that made altitude more difficult on that day than average.

The one thing I disagree with a bit is
MountainMedic wrote:In other words, this won't keep happening to you unless you're just unlucky (adjustment to altitude is almost entirely genetic).


It may/will happen again if it's a long period of time before the next trip to altitude and nothing else changes (similar previous acclimatization, excessive fluids, no prophylactic ibuprofen, etc.). That is, could go either way -- so worth heeding much of the advice on the thread.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby greenhorn1 » Thu Sep 20, 2012 5:09 pm

tehchad wrote:
climbingaggie03 wrote:HAFE High Altitude Flatus Expulsion http://en.wikipedia.org/wiki/High_altitude_flatus_expulsion it's on wikipedia, it must be true.


I'm in tears!!!! :lol: :lol:


Same here!

I guess that explains all the pairs of blown out underwear stashed in the woods I've been seeing at the beginning of 14ers hikes...
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Re: 14er newbie - frequent urination while hiking, AMS??

Postby Tortoise1 » Thu Sep 20, 2012 5:19 pm

What other forum could do 82 posts on peeing at altitude? Quality, illuminating posts too. I dare say that there's no other forum that could even come close.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby Fishdude » Thu Sep 20, 2012 9:30 pm

I am with the OP; it is TWB (teeny weeny bladder). Happens to me all the time. Less often if I am drinking gatorade and less often as I descend and am getting a bit dehydrated.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby MountainMedic » Thu Sep 20, 2012 9:54 pm

madbuck wrote:
The one thing I disagree with a bit is
MountainMedic wrote:In other words, this won't keep happening to you unless you're just unlucky (adjustment to altitude is almost entirely genetic).


It may/will happen again if it's a long period of time before the next trip to altitude and nothing else changes (similar previous acclimatization, excessive fluids, no prophylactic ibuprofen, etc.). That is, could go either way -- so worth heeding much of the advice on the thread.


Well yeah, you can certainly deacclimatize. But if you keep climbing and your hemoglobin "adjusts" (2,3-DPG, for those science folks), you shouldn't continue to have this problem. I've had terrible AMS twice but after a couple weeks of training I can run at 14K without really feeling the altitude. After breaking my left ankle last year I was at sea level for quite some time, and I really couldn't handle the altitude. But after 2-3 climbs, it all came back. Your body will adjust to whatever environment it's in, and if you're "genetically lucky," it will do so quickly.

Just to clarify: Ibuprofen is virtually worthless. Acetazolamide works well and acetominophen is decent. Ibuprofen is the third best choice and really does next to nothing. Furthermore, there's some evidence that, while acetazolamide mimics the body's natural adjustment to altitude, ibuprofen counters it. Don't go up there with a bunch of Advil assuming it will solve your problems, cause it won't.

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