Scientists will often tell us that case studies are of little use. They’ll say that they’re not representative, that they’re unusual "one-offs" and they shouldn't alter the way we behave. However every now and again a case comes along that is so disturbing that it’s hard to ignore.

In the spring of 2009 a young American climber set off to climb Mt Everest. Shortly before departing he visited his family doctor to discuss the trip. On hearing of his plans, the doctor prescribed a course of drugs to aid his acclimatisation and boost his chances of reaching the summit.

Fast forward four weeks and our climber is about to make his first sortie into the Western Cwm. Before departing he noticed a rash over his abdomen and decides to stop taking the drugs he’s been taking. Three days later he stumbles into Camp 3 (7010m) where he collapses, confused and disorientated. Only through the efforts of his climbing team and local Sherpa staff was he able to descend to Base Camp.

What happened? Tests in Kathmandu showed that one of the drugs was to blame. Dexamethasone, a powerful steroid, had damaged the lining of the stomach and caused a massive amount of bleeding. Since red blood cells carry oxygen, he was losing them just at a time when they were most needed. To make matters worse, his body had come to depend upon dexamethasone and had “switched off” its own steroid production. In life threatening situations this can be catastrophic since steroids play a key role in the body’s response to stress.

Whilst our climber survived his ordeal, he was left with a long list of physical and psychological problems that have required ongoing treatment. So what’s the “take home message”? Steroids have life threatening side effects. Predicting who will or won’t develop them is very difficult. The only “risk free” approach is to avoid steroids altogether and rely upon your body to make its own adjustments to the stresses of altitude.

This case study is available as a free download from:

http://download.journals.elsevierhealth.com/pdfs/journals/1080-6032/PIIS1080603210002991.pdf

Article compiled by Dr Jeremy Windsor, Mountain Section Editor of the Wilderness and Environmental Medicine Journal, BMC UIAA Medcom representative. 3/4/12

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