COCA in SOROCHE, the ANDEAN ALTITUDE SICKNESS

The altitude sickness is a hypoxic syndrome, due to oxygen decrease, resulting in inadequate blood’s oxygenation in the human body, in subjects reaching high levels of altitude.

Not all individuals exposed to high altitude show the corresponding clinical symptoms; with certainty we only know that the majority of symptomatic cases occur during the first few days at altitude: the only safe treatment is the descent to a lower altitude.

Ethiology and pathophysiology

The atmospheric pressure decreases with the increasing of altitude, but the percentage of oxygen stays constant; consequently the partial pressure of oxygen in the air decreases at high altitude; at 5500 m (18000 feet) it’s about the half than at sea level

The 15% of people going up to 2700 m (9000 feet) and above, in less than a day, departing from sea level, presents symptoms of high altitude sickness.

The symptoms may return when facing high altitude, at different times, unpredictable and variable even in the same person, in different physiological situations; children are at highest risk, when under the age of 6 years, as well as women in premenstrual phase.

Hypoxia stimulates the breath that, in turn, increases tissue oxygenation, but also causes respiratory alkalosis which contributes to the symptoms, until it is offset by a loss of HCO3 in the urine. Hypoxia affects the sodium pump oxygen-dependent, with sodium and water accumulation within cells and potassium passage outside; it seems that the consequent swelling of cells be the essential physio-pathological element in the high altitude sickness. In some subjects the hypoxia can stimulate the hypersecretion of ADH with fluid retention.

Six factors are identified as responsible for the incidence and severity of altitude sickness:

1. Rapidity: the quicker one goes up, the higher the risk.

2. Reached level, especially where one sleeps: the higher one sleeps, the higher the risk.

3. Exposure time: the longer one stays at high altitude, the higher the risk

4. Intensity of physical activity: it increases the risk, if intense, with no rest and poor oral hydration,

5. Oral hydration and nutrition: a high in fat and protein diet and dehydration increase the risk.

6. Individual physiological susceptibility: some people are more predisposed, but none knows why.

Classification

The three types of altitude sickness include:
1. Acute mountain sickness, AMS
2. High altitude Pulmonary Edema, HAPE
3. High altitude cerebral Edema, HACE

AMS is the most common form, which does not involve life-threatening, but, if not correctly taken care, may evolve towards HAPE, less common, but more serious, or HACE, a rare form, but sudden and very severe.

Prevention

The prevention of altitude sickness is realized with a gradual approach to high altitudes, with stops at intermediate altitudes to acclimatize, especially sleeping there; the human body immediately begins the emergency adaptation to high altitude, but it requires several days to stabilize the long-term adaptation mechanisms.

The way up to altitude should be much slower, if one lives very close to sea level; a light diet is recommended, in small amounts, several times a day, rich in carbohydrates, fat-free, along with a good hydration with plain water and herbal infusions; exercise should be gradual, for duration and intensity.

A clinical-therapeutic experience

In the Andean region a peculiar manifestation of altitude sickness is named soroche, which occurs frequently in tourist areas in the Andes: Cusco (Peru), Titijaja Lake (border Peru-Bolivia) and La Paz (Bolivia).

The hardest hit are the tourists arriving at high altitude after a short flight from sea level in less than an hour; after a little rest and a cup of mate de Coca, infusion of leaves of the sacred plant of the Andes, given the limited time available to explore the many natural wonders and the archaeological and traditional sites of the Andean region, tourists get on their way, underestimating the impact of 3000 and more meters on the human body, still not adapted to high altitude.

In Cusco, the archaeological capital of America, in southern Peru, at 3250 meters, within the projects of the Association K’uychiwasi, an area was devoted to emergency medical volunteer service, assisting about 240 people who required help, being affected by the symptoms of soroche.

The cases taken under care can constitute an interesting clinical experience, both preventively and therapeutically, for the positive results obtained from the use of natural Coca, adopted in all cases of soroche.

It is assumed that the Andean Coca is effective in the treatment of soroche, thanks to the package of nutrients and alkaloids contained, including the globulins, heart tonic protein, with an effect – perhaps better being natural – similar to coramine glucose; the synergy of all the components of Coca is the main key of the immediate therapeutic response, in terms of cardiorespiratory stabilization, improvement of the oxygenation and the vital signs, by reducing anxiety and inducing a feeling of wellbeing, albeit with some residual fatigue.

The natural alkaloid cocaine contained in Coca leaves, one among the 14 known, is largely eliminated by temperature of at least 70 degrees centigrade, when the green flour of Coca, aggregated to the other ingredients, is boiled or baked, when elaborating some foods, such as cookies, candy, chocolates, breads and others.

All the treated cases, including people from all over the world, had a global positive response to treatment with natural green Coca, despite the variety of cultural, ethnic and social aspects, as well as different tastes, customs and reactions to adaptation.

Symptoms

The symptoms, multifaceted in their presentations, occurred in varying degrees of severity, regardless of the subject’s basic general conditions:

-70% of cases presented a classic clinical picture of hypoxia, arterial hypotension, tachycardia, hypothermia, torpor, headache, drowsiness, nausea.
-15% of cases showed a gastrointestinal tract clinical picture with nausea, vomiting, diarrhea.
-15% of the total number of cases presented the combination of the two clinical conditions above described.
-90% of pediatric cases, that’s about the 10% of overall adults, presented gastrointestinal symptoms.

Since the geo-ecological and climate characteristics of the Andean region are known to travelers, tourist population is automatically selected and, therefore, rare are the cases of elderly people taking the risk of adventuring up to high altitude, as well as of people affected by chronic cardiorespiratory diseases: in the case of soroche they would require an immediate evacuation to lower altitudes, to be assisted with intensive medical therapy.

Treatment

The considered medical cases of soroche responded favorably to therapy with the natural green products with Coca, according to the following protocol, handled, as far as possible, in the mother tongue of the patient:
-Patient lying in a position facilitating the venous return
-Adequate protection against the common sensation of intense cold
-Psychological reassurance on the benign nature of soroche
-First check of blood pressure and pulse rate
-Personal data and general history collection
-Administration of a cup of mate de Coca, prepared with ground leaves, brown sugar, lemon juice and boiling water and/or oral administration of 3 toffees made out of Coca and Andean cereals or 3 minced lemon candies
-Second check of blood pressure and pulse rate, ten minutes after taking the Coca products.
-Patient in a sitting position for ten minutes
-Third and final check of blood pressure and pulse rate
-Maintenance recommendations: rest, oral hydration, light diet and the green products with Coca
-Discharge of the patient

Conclusion

The overall cases responded to the intake of products with green Coca. In 8 patients, positive for chronic heart disease, oxygen therapy was administered. According to the preference and the patient’s condition, Coca products in liquid or solid form have been selected. The children were  preferentially given some solid products.