Six selected cases from a year's experience as advisory doctor to a commercial mountaineering expedition company

A review of six patients requiring medical assessment prior to joining commercial mountaineering trips. Medical problems encountered include malaria risk with immunosuppression, renal transplant recipients climbing at altitude, coronary artery disease risk at altitude, cardiac pacemaker function at altitude, and diabetes with remote-area travel. Cases also illustrate personal and commercial risk assessment and potential international differences in legal duty of care. It is hoped that these cases will stimulate debate and thought regarding the preventive aspects of altitude-related medical problems. This can be achieved by education of the general mountaineering population in altitude- and expedition-related medical matters, combined with individual pretrip advice for patients.