Acute Mountain Sickness and Importance of Acclimatization

We all want to enjoy the lovely nature and breathtaking views of Himalayas. While going to Himalayas, many of us take the high altitudes very lightly and always consider the brighter side of it i.e majestic vistas . However, there is a darker side attached to the high altitudes as well. How many times have you been to high altitudes and either you or people around you complained that shortness of breath, nausea, headaches or vomiting etc? I am sure you must have encounter such uncommon situations while in the Himalayas especially at the high altitudes like regions of Manali – Leh Highway, Leh – Ladakh, Rohtang Pass, Spiti Valley in India to name a few. To be very frank, some people suffer mildly and some may not suffer altogether; consider your self very lucky in such a case. However, some persons suffer drastically and the effects can be seriously ugly from them.

Illness or sickness on Himalayan trips is very common especially if you are directly flying or driving to a higher altitude which almost certain the chances. Such Illness can spoil a much awaited relaxing holiday into something ugly and in some cases may have severe consequences too. Higher you go directly, higher will be the risks. Hence, its always better to know what the altitude sickness means and what we can do to prevent it. Further in the article, I try to lay out some important theory and facts about the mountain sickness and acclimatization which may help you be prepared for altitude changes and enjoy that ever awaited holiday of yours .

Acclimatization and Acute Mountain Sickness (AMS)

Altitude can be categorized into the following scales –

• High (8,000 – 12,000 feet [2,438 - 3,658 meters])
• Very High (12,000 – 18,000 feet [3,658 - 5,487 meters])
• Extremely High (18,000+ feet [5,500+ meters])

Generally, people can go up to 8000 feet without much problems of mountain sickness. As you start to increase altitude, the barometric pressure starts to decrease which reduces the Oxygen intake per breath. Now, in order to compensate for the less Oxygen intake, your body need to increase the breathing rate. Although the increased breathing rate does increase the Oxygen level in the blood but it does not take the Oxygen level to the same level as required by the body while you are at home doing some activity. By spending proper amount of time at such altitude your body will adapt to such changes in Oxygen levels and this process is called as acclimatization.Always keep in mind that different people will acclimatize at different rates. Hence, always try to avoid any sought of comparison and wait for the person suffering in the group better acclimatize.

Acute mountain sickness (AMS) is caused above the altitudes of 10,000 Feet or 3,048 Mtrs to majority of people. Higher is the elevation and rate of ascent, more will be the effects of AMS. Hence, do not try to directly go or stay at very high altitudes directly. When you sleep, the symptoms will get worse as our body respiration decrease while sleeping.

The best cure is either to acclimatize properly or descend. However, effects of mild AMS can be cured by taking some preventive AMS medicines like headache pain relief or Diamox with proper consultation and prescription with your doctor or physician prior to the start of the trip. Diamox is a sulfa drug and does have side effects including allergies. Hence, Diamox shall only be taken after proper prescription by your doctor or physician. Diamox can also be helpful in case a person suffer from periodic loss of breath, which especially occurs in the night while sleeping.

Incase, you feel the personal is suffering badly then ask him to walk in a straight line by placing toe to toe. If the person is not able to walk in a straight line i.e. he is suffering with ataxia. IMMEDIATELY DESCEND!!

Tips for Better Acclimatization

Below are few tips that will certainly help you in better acclimatization:

Increase the altitude gradually

The acclimatization rules states that after 10,000 feet we must stay overnight for every 1000 feet or 305 Mtrs of elevation in order to properly acclimatize our body. This schedule in between shall allow a complete day acclimatization rest after 3000 feet or 915 Mtrs with overnight stay at the same altitude. If you can adjust your plan to this rule then perhaps you will not suffer with mountain sickness. However, the ground reality is only few people stick to this schedule especially in India where leaves are hard to find from their work life .

Keep your body properly hydrated

Do take plenty of intake of water with ORS or fluids like milk tea, juice, soup (garlic one will do wonders). If possible, take ORS soluted water or ORS – L tetra packs with you to replenish the lost nutrients immediately. Also, garlic flavored water ( keep garlic in water bottles) will help much more than drinking plain water which shall be avoided. This will help keep the oxygen level to normal in the body. You should avoid too much black tea or coffee as well…

AVOID over hydration because as quoted by vistet linked here(post #12):-
Forcing children to drink when they are not thirsty : at best they will vomit ( which will force you to descend ) , at worst they´ll start to develop cerebral edema – either only from water intoxication , or as a mixed result from this and altitude sickness. See for example Peter Hackett ( Everest-climbing doctor and co-author of the CDC altitude advisory ) on this : ” Too much water is harmful and can dilute your body’s sodium levels (hyponatremia) causing weakness, confusion, seizures, and coma.”

Avoid sleeping at high altitudes

As sleeping decrease the respiratory drive of our body, it is recommended that one shall hike to high altitudes in the day but should always come back to by the evening to sleep at lower altitude.

Avoid over exertion

Do not over exert your body with any unnecessary physical activity which may lead you pump more breath.

Avoid tobacco and smoking and alcohol and other depressant drugs

Avoid tobacco and smoking and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.

Keep your body warm

Keep your body warm with woolens and do not let it cool. Make sure your clothes are always dry.

Eat lots of Carbohydrates

Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.

Avoid sleep during the day

Try not to sleep during the day and keep yourself involved in some light activity during the day. Respiration decreases during sleep which further exacerbate the symptoms.

Sleep in upright position, if possible

Try to lay down or sleep by resting your back against the wall. If you cannot sleep in such mode then do not flatten your head on the bed rather place a bag below your head and then one or two pillows and then sleep in such a posture. It will help you keep your head much lighter.

Carry preventive medicines for AMS

Do take preventive AMS medicines along with you on the trip but only after consultation with your doctor or physician because the AMS medicines may lead to some side effects too. If you are not sure about any allergy with these medicines then try them one or two week before you plan the trip. Check to see if there are any allergic effects and decide.

Carry Small Oxygen Kit

If possible, you may also carry a oxygen cylinder to counter the AMS symptoms. It will certainly help as a supplement but do take proper consultation from your doctor for the intake amount of oxygen, before the trip.  Oxygen intake will help you incase of any emergency and will spare you more time to descend to lower altitudes as soon as possible.

A note from the pioneer, Vistet linked here at post #12: on oxygen cylinders:
Small tanks of even medical grade oxygen provides a false sense of security : they will at extreme best last for an hour or two. For the value of cheap , portable oxygen solutions see here, # 5 and #7 check here

Immediately descend, if symptoms increase

Last but not the least, if the AMS symptoms start to increase then you should consider immediate descend. This is the only cure in some conditions when the symptoms have reached moderate levels and are not decreasing.

Symptoms of Acute Mountain Sickness (AMS)

Below is the categorization of symptoms for different levels of Acute Mountain Sickness (AMS) along with indicative cure for it…

AMS Symptoms	AMS Level	Possible Cure
Headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and a general feeling of malaise	Mild	Medication or Descend
Decreased coordination (ataxia), Severe headache (not relieved by medicine), other mild level symptoms with increased affect	Moderate	Advanced Medication or Descend  about 305-610 Mtrs
Inability to walk, decreasing mental status, and fluid build-up in the lungs	Severe	Immediate Descend about 610-1,220 Mtrs

Taking baby or kid to high altitude?

Many a times when you want to travel to high altitudes, you may likely to worry for your kid or baby or infant. Well, personally I suggest you travel with kid or infant atleast 12 months old. However, studies suggest its safe to travel with an infant more than 3 months old IFF he/she is not born prematurely or do not suffer from any illness. NEVER travel with a baby less than 3 months old. While the above tips are helpful for kids or babies above 3 months old as well but there are other tips which need special attention for traveling with Kids and babies. I have tried to cover the details for traveling with babies or kids in the link below: Traveling to High Altitude with Kids or Babies

References

If you need more detailed information about Acute Mountain Sickness, then you may read the following links as well…

• Outdoor Action Guide to High Altitude: Acclimatization and Illnesses
• Altitude acclimatization for trekking – 10 golden rules
• Altitude Illness Clinical Guide For Physicians
• An Altitude Tutorial

Please share your valuable comments on acclimatization and acute mountain sickness or if you like the article and it could be of some help for you too.

Having said all that, it is still recommended that you CONSULT A DOCTOR or PHYSICIAN before you make a trip to a high altitude region just to ensure everything is in right place. Again, these are just my suggestions based on my very limited or negligible knowledge of AMS or mountain sickness but I will definitely suggest you that you consult some physician or doctor before going on the trip because I am not any of them. For more details on the same you MUST READ the links mentioned in the references which explains it in better details