Acute Mountain Sickness

If you are not feeling well at altitude, it’s altitude sickness until proven otherwise.

Anyone could be struck by the altitude sickness, even at relatively low altitudes such as 8000 ft. (2450 m). But in general people going in higher altitudes in rush without proper acclimatization are more severely affected. People who fly to a high altitude and then proceed to an even higher area or cross a pass should be especially wary. So, those hiking up will have fewer problems than those flying up. Serious illness occurs in perhaps less than 2% of people who go to high altitudes.

Altitude illness can be prevented by acclimatization that is by a gradual rate of ascent, allowing sufficient rest at various intermediate altitudes. The proper amount of rest and rate of ascent vary greatly from individual to individual. Dr. Charles Houston, who has done extensive research at high altitudes, says a cautious rate of ascent that would ensure comfort and safety for almost anyone is to take five days to reach 11,000 ft. (3350 m) and six more days to reach 15,000 ft. (4500 m). Above 15,000 ft. (4500 m), climb 500 ft. (150 m) a day.

There are other factors besides a slow rate of ascent that help in acclimatization. A large fluid intake to ensure good hydration is a key. Four liters or more a day of liquid are usually necessary. This can be water, tea, soup, or broth. Alcoholic drinks should be avoided by dehydrated individuals and at high altitudes by everyone. The effect of alcohol in high altitude may be impossible to distinguish from symptoms of altitude illness.

Proper nutrition is another factor in acclimatization. Caloric intake should be maintained and the diet should be high in carbohydrates. The tasty potatoes found at high altitudes in Nepal are an excellent source of carbohydrates. A good appetite is a sign of acclimatization. Avoid an excessive salt intake at high altitudes. Don’t take salt tablets.

Rest is also important. Over – exertion does not help acclimatization. Give up part of your load. Avoid going so fast that you are always stopping short of breath with your heart pounding. You can plan modest objectives for each day so that you will enjoy your stay in the heights.

Deep breathing helps to reduce the mild symptoms of altitude sickness. However, if done to excess, it can produce the hyperventilation syndrome in which shortness of breath, dizziness, and numbness are present. Breathing in or out of a large paper or plastic bag for a few minutes will relieve these symptoms.

Finally there is a drug that may help in coping with high altitude in certain situations. Diamox has been shown to be beneficial in those who fly to high altitudes. The dose is 250 mg by mouth twice a day begun two days before the flight and continued for three days after ascent. Side effects often noted are an increased urine output, and some numbness and tingling. Trekkers flying into a high altitude area such as Lukla, Shyangboche, Jomsom or Manag might consider taking it. They should not take it routinely because of its side effects. The drug only prevents certain symptoms and not the serious life threatening ones.

Most people trekking to high altitudes experience one or more mild symptoms of altitude illness. The symptoms include:

• Nausea
• Loss of appetite
• Mild shortness of breath with exertion
• Sleep disturbance
• Breathing irregularity, usually during sleep
• Dizziness or light headedness
• Mild weakness
• Slight swelling of hands and face
• Serious Symptoms of altitude illness are a grave matter. They include:
• Marked shortness of breath with only slight exertion
• Rapid breathing after resting – twenty five or more breaths per minute
• Wet, bubbly breathing
• Severe coughing spasms that limit activity
• Coughing up pinkish or rust – colored sputum
• Rapid heart rate after resting – 110 or more beats per minute
• Blueness of face and lips
• Low urine output – less than a pint (500 ml) daily
• Persistent vomiting
• Severe, persistent headache
• Gross fatigue or extreme lassitude
• Delirium. confusion and coma
• Loss of co-ordination, staggering

If anyone in your party develops any of these symptoms, he or she should descend IMMEDIATELY. Dr. Peter Hackett states, “There are three rules for treatment: descent, descent, descent!” The victims should be kept warm and given oxygen if it is available. After a descent of several thousand feet, relief may be dramatic.

Altitude illnesses observed in Nepal include: Acute Mountain Sickness (AMS), High Pulmonary Edema (HAPE), Peripheral Edema (PE), Cerebral Edema (CE), High Altitude Retinal Hemorrhage (HARH), and High Altitude Flatus Expulsion (HAFE).

AMS: This comes at high altitudes for one or two days. Different symptoms are experienced. If anyone has persistent headache or mild symptoms also occur. The rate and depth of respiration increase to a peak. If none of the symptoms are present, there is no cause for concern. Young people seem to be more susceptible to AMS. The treatment is to deal with each symptom with whatever means you have, and to ascend slowly or rest, depending on the severity of the problem.

HAPE: The presence of fluid in the lungs, is a grave illness and is probably present if the respiratory problems on the above serious symptoms list are noted. The heart and breathing rates are useful clues. Do not delay in descending with individuals with these symptoms as death can be only a few hours away.

PE: Swelling around the eyes, face, hands, feet or ankles – is present in some degree in many visitors to high altitudes. Women seem to be affected more than men. Rings on the fingers and constricting clothing or pack straps should be removed or loosened. Such swelling can be an early indication of failure of the body to adapt to high altitudes. You could better descend down, if you have further complications.

CE: Swelling of the brain is the serious disorder that has killed quite a few. It usually occurs after a week at high altitudes and begins with mild symptoms that progress to the serious ones. Usually the heart and lung symptoms are not prominent. Characteristic features are severe lassitude, lack of coordination and total apathy, leading to coma and death. Do not leave such person alone assuming that he is tired. Oxygen and steroids may be useful adjuncts in treatment.

HARH: Bleeding in the retinas of the eye is more common at extreme altitudes than at those the trekker is likely to reach. It does happen to trekkers occasionally and usually symptomless unless the vision clouds somewhat. Vision clears and bleeding resolves at lower altitudes.

HAFE: The production of increased amounts of intestinal gas seems endemic up high. This recently described ailment does not seem to be serious but does cause problems to those around the sufferer. There is no effective treatment or known prevention.

All this may seem frightening to the trekker bound for the heights, but the information has to be put in perspective. If you have not been to the high altitudes, do not be scared away from enjoying the mountains of Nepal. Be prudent. Know the symptoms of altitude illness and what to do about them. Enjoy the country and its people in all their varied beauty.