Acute Mountain Sickness and Importance of Acclimatization

By Dheeraj Sharma on May 20, 2011 00:05 in Ladakh, Travel Articles / 96 comments

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 :lol:.
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 theyll 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 bodys 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
Descendabout
610-1,220 Mtrs