Acute Mountain Sickness

At Alpine Eco Trek your Safety is our First Priority:

Your safety is always at the top of any agenda while organizing any of the adventure trekking and climbing trip in the Himalayas. All our trip leaders and trekking guides are medical trained, experienced; work permanently for us and each year train and update their skills on the Wilderness First Aid Training. They are experts in coping with any problems that may arise on any trip to ensure all of you have a safe and best trekking and climbing expedition. You can have complete trust/confidence in our expertise and knowledge. Your safety on any trip is on top priority. We carry a comprehensive medical kit in each of the high altitude trekking and climbing trips in the Himalayas. We plan adventure travel trips so that safety and comfort is not compromise. Acute Mountain Sickness could be life threatening while trekking at higher elevation in Himalayas.

What is Acute Mountain Sickness?

Generally it happens when our body fails to acclimatize to the decreasing amount of oxygen available on high altitude as we ascend higher above 3000 meters. Alpine Eco Trek trip itineraries have been professionally designed to minimize the effects of altitude sickness.
Extensive medical kits are carried on all our trips. All our group leaders / guides are well trained in Wilderness First Aid Course to recognize any symptoms and to act accordingly on the very spot. However we do suggest you get advice from you travel doctor or health advisor beforehand.

Prevention of Acute Mountain Sickness (AMS)

  • Allow sufficient time for acclimatization (After 3,000 meters).
  • Do not make rapid Ascend or go too far too fast.
  • No alcohol, no smoking and no any sleeping pills.
  • Drink more fluid 3 to 4 liters a day, clean water – boiled or treated / tea / coffee / soup / juice etc.
  • Hike high and sleep low.
  • Do not trek/travel alone, take guide/porter.
  • Follow the advice from trip leader and guides.
  • Descent if mild symptoms rapidly getting worse.
  • Never leave or descent sick person alone.
  • Avoid getting cold and cough.

AMS become common above 3000 meter and present in the following ways:

  • Acute Mountain Sickness (AMS) is the most common and is not life-threatening.
  • HACE (High Altitude Cerebral Edema) is a life-threatening illness that can develop from AMS.
  • HAPE (High Altitude Pulmonary Edema) is a life-threatening illness; it may occur on its own, or with AMS or HACE.

AMS symptoms and signs should expect but not worry

  • Headache (typically throbbing, often worse for bending over or lying down), PLUS one or more of the following symptoms:
  • Tiredness, weakness.
  • Dizziness, light headedness.
  • Loss of appetite, nausea (or vomiting).
  • Insomnia, disturbed sleep, frequent waking.

Treatment:

  • Rest (avoid even the slightest exertion if this is possible) at the same (or lower) altitude until the symptoms clear (up to 4 days).
  • Drink enough to keep your urine pale and plentiful.
  • Use ibuprofen or paracetamol for headache.
  • Take Diamox (125 to 250 mg 12-hourly) for 3 days, or for the rest of the time at altitude if symptoms return.
  • Consider Stemetil (or other anti-vomiting medication) for persistent nausea/vomiting.
  • If AMS symptoms are severe, give oxygen (1 to 2 L/min) OR use a pressure bag until symptoms clear.
  • Check the victim regularly for signs of HAPE and HACE, especially during the night.
  • Descend far enough to clear symptoms (at least 500m/1640ft) if symptoms of AMS do not improve or get worse.

Facts on HAPE and HACE:

  • HACE or HAPE occur in approximately 1 to 2% of people going to high altitude.
  • HAPE and HACE may occur alone or together.
  • HAPE is roughly twice as common as HACE.
  • HAPE causes many more deaths than HACE.
  • HAPE may appear without any preceding symptoms of AMS.
  • HAPE is more likely in people with colds or chest infections.
  • HAPE often comes on after the second night spent at a higher altitude.
  • HAPE can develop even after descending from a higher altitude.
  • HACE usually develops after symptoms of AMS have appeared and often gets rapidly worse during the night.
  • HACE may develop in the later stages of HAPE.

HACE (High Altitude Cerebral Edema)

Symptoms of HACE are caused by an accumulation of fluid in or around the brain. Typically symptoms and signs of AMS become worse and HACE develops. Someone with HAPE may also develop HACE.

Symptoms and signs:

  • Severe headache, which often feels worse on lying down and is not relieved by ibuprofen, paracetamol or aspirin.
  • Tiredness, severe fatigue.
  • Nausea and or vomiting which may be severe and persistent.
  • Loss of coordination, clumsiness. The victim needs help with simple tasks such as tying their shoelaces or packing their bag. They cannot do the finger-nose test.
  • Staggering, falling. They cannot do the heel to toe walking test or the standing test.
  • Blurred or double vision, seeing haloes around objects.
  • Loss of mental abilities such as memory. They cannot do a simple mental arithmetic test.
  • Confusion, hallucinations.
  • Change in behavior (aggression, apathy, etc.).
  • Drowsiness, difficult to wake up, coma, death.

Tests for HACE

Heel-to-toe walking test: The victim is asked to take 10 very small steps, placing the heel of one foot to the toes of the other foot as they go. Reasonably flat ground is necessary and the victim should not be helped

  • Standing test: The victim stands with eyes closed, feet together and arms by their sides
  • Finger-nose test: With eyes closed, the victim repeatedly and rapidly alternates between touching the tip of their nose with an index finger then extending this arm to point into the distance (a useful test if the victim is in a sleeping bag)
  • Mental arithmetic test: Give the victim a mental arithmetic test, eg. subtract 7 from 100, 7 from 93, and so on (but remember some people may be poor at arithmetic even at sea level)

If the victim cannot do any of the above tests easily (or refuses to cooperate), or show excess wobbling or falling over in the two first tests (be prepared to catch the victim if they fall over!), assume they are suffering from HACE. If in doubt about the victim performance, compare with a healthy individual. Be prepared to keep repeating these tests.

Treatment:

Descend immediately (prompt descent will begin to reverse the symptoms). Descend as low as possible, at least 1000m /3280 ft. Descend at night or in bad weather if necessary. Carry the victim if possible, as the exertion of walking can make the illness worse

If descent is not immediately possible (eg. dangerous terrain or weather, not enough helpers or while waiting for a helicopter), oxygen use will keep the person alive until descent can be undertaken.

Give medications:
i) 8 mg of dexamethasone at once (by mouth, IV or IM) followed by 4 mg 6-hourly. Dexamethasone takes several hours to work. Stop it once below 2500m/8200ft AND after at least 3 days of treatment by tailing off the dose slowly (give the last 3 doses 12-hourly).
ii) Diamox 250 mg 8 to12-hourly.
iii) Treat persistent vomiting with anti-vomiting medication.

Prop the victim up in a semi reclining position as lying down flat may make their condition worse.

Avoid even the slightest exertion if this is possible. Even walking a few steps may make their symptoms worse or reappear. Do not leave the victim alone.

If a person is turning blue or is falling into unconsciousness, give them rescue breathing before they stop breathing.

HAPE (High Altitude Pulmonary Edema):

Symptoms of HAPE are due to the accumulation of fluid in or around the lungs. It may appear on its own without any preceding symptoms of AMS (this happens in about 50% of cases), or it may develop at the same time as AMS. HAPE can easily be mistaken for a chest infection or asthma: if in doubt treat for both.

Symptoms and signs:
A reduction in physical performance (tiredness, severe fatigue) and a dry cough are often the earliest signs that HAPE is developing
Breathlessness. In the early stages of HAPE, this may mean just taking a bit longer to get one breath back on resting after mild exercise. Later on, there is marked breathlessness with mild exercise. Finally, breathlessness occurs at rest. Record the respiratory rate (NB: At 6000m/19700ft, class=”normal” acclimatized respiration rate is up to 20 breaths per minute)
The dry cough may later become wet with frothy sputum, which may be bloodstained (pink or rust colored). This is a serious sign
Wet sounds in the lungs when breathing in deeply (place your ear on the bare skin of the victim back below the shoulder blades; compare with a healthy person). Note: There may be NO wet sounds in even quite severe HAPE: this is called dry HAPE.
There may be: mild fever up to 38.5 C, a sense of inner cold, pains in the chest
Blueness or darkness of face, lips, tongue or nails due to lack of oxygen in the blood (cyanosis)
Drowsiness, difficulty waking up, coma, death...

HAPE (High Altitude Pulmonary Edema):
Symptoms of HAPE are due to the accumulation of fluid in or around the lungs. It may appear on its own without any preceding symptoms of AMS (this happens in about 50% of cases), or it may develop at the same time as AMS. HAPE can easily be mistaken for a chest infection or asthma: if in doubt treat for both.

Symptoms and signs:
--A reduction in physical performance (tiredness, severe fatigue) and a dry cough are often the earliest signs that HAPE is developing
--Breathlessness. In the early stages of HAPE, this may mean just taking a bit longer to get one breath back on resting after mild exercise. Later on, there is marked breathlessness with mild exercise. Finally, breathlessness occurs at rest. Record the respiratory rate (NB: At 6000m/19700ft, class=”normal” acclimatized respiration rate is up to 20 breaths per minute)
--The dry cough may later become wet with frothy sputum, which may be bloodstained (pink or rust colored). This is a serious sign
--Wet sounds in the lungs when breathing in deeply (place your ear on the bare skin of the victim back below the shoulder blades; compare with a healthy person). Note: There may be NO wet sounds in even quite severe HAPE: this is called dry HAPE.
--There may be: mild fever up to 38.5 C, a sense of inner cold, pains in the chest
--Blueness or darkness of face, lips, tongue or nails due to lack of oxygen in the blood (cyanosis)
--Drowsiness, difficulty waking up, coma, death..

Treatment:
Same general treatment as for HACE, EXCEPT:
Give medications:
i) Nifedipine. This should only be used if bottled oxygen or a pressure chamber is not available and the victim is warm and well hydrated. Give the modified release (MR) form of the tablets (20 mg 12-hourly for 2 or 3 days). If a fall in blood pressure occurs due to nifedipine (pallor, weak rapid pulse, dizzy on standing), treat as shock
ii) Diamox 250 mg 8 to 12-hourly
III) An asthma reliever spray (2 puffs 4-hourly) may help.

Medicine checklist:
•    Acute Mountain Sickness- Diamox, dexamethazone
•    Antiseptics (disinfectant): Dettol, iodine solution, Burn cream (Silvazine, Burnol).
•    Pain Killers (analgesics): Paracetamol (Panadol), Aspirin, Ibuprofen.
•    Antibiotics (infection): Amoxycillin, Cephalexin, Ciproflixacin, Cotrimoxazole, Doxycycline, Erythromycin, Metronidazole, Tinidazole,
•    Eye and Ear Infection: Chloramphenicol
•    Fungal infection: Miconazole
•    Nausea and vomiting-Stemetil
•    Indigestion Antacid tablets
•    Constipation Durolax
•    Anti Motility Immodium, lemotil
•    Acute Mountain Sickness Diamox, dexamethazone,
•    Respiratory Medication: Sinutab, lemotab, Asthma spray.
•    Anti Allergy and Anti Inflammatory: Hydrocortisone cream Calamine, Polaramine
•    Dental Clove oil
•    Instruments: Thermometer, tweezers, scissors
•    Dressing and wound: cotton buds and roll, square and sterile gauze, triangular, adhesive and elastic bandages..