High altitude sickness in Nepal Trekking

Altitude sickness is known as an Acute Mountain Sickness (AMS). Generally it occurs when people

ascend up to the high altitude too quickly [generally above 3000 m]. AMS occurs when the body does not adapt well to the lack of oxygen present at higher altitudes. At 5490 meters (18,000ft), there is just half the oxygen available as there is at sea level, while there is only a third available at the summit of Mount Everest. The itineraries of the treks of Agile Adventure Treks are designed to reduce the risk of altitude sickness as much as possible, although individual susceptibility to altitude sickness seems to be genetically determined.

What happens to the body during altitude illness? 

• The body tries to adapt to having less available oxygen by increasing the rate and depth of breathing, as well as the heart rate.
• Fluids accumulate in between the cells in the brain, the lungs or both, creating mild to severe symptoms.
• Mild symptoms include headache, loss of appetite, nausea, fatigue, insomnia and dizziness.
• These symptoms are usually resolved by spending one or two extra nights at the same altitude.
• If symptoms worsen, descent to lower altitudes is warranted.
• If you are resting at the same altitude and your symptoms worsen, then it is also necessary to descend.
• More serious symptoms of AMS include increased tiredness, severe headaches, vomiting, loss of coordination, shortness of breath and coughing fits.
• These extremely dangerous symptoms are called high altitude cerebral edema (or HACE). They can lead to unconsciousness and death within 12 hours.
• Increasing shortness of breath, cough and tiredness may also be signs of high altitude
• pulmonary edema or HAPE. This condition can rapidly prove to be fatal if ignored.
• Respiratory depression (the slowing down of breathing) can be caused by various substances, and may be a problem at altitude.

What you have to do if you get mild symptoms:

• If you get mild symptoms, stop and relax (with your head out of sun) and drink some fluids frequently.
• Stop and have a rest more and take 125-250mg Diamox, it generally takes one to four hours to be cool down.
• Take 125-250mg Diamox in the evening and drink plenty of fluids.
• If you feel a bit better, don't leave taking precautions at the point, take another 250mg Diamox 6-8 hours later.
• If the symptoms continue to get worse, try to descend down, acclimatize and again ascend up.

The symptoms of serious AMS:

• Persistent and severe headache.
• Persistent vomiting.
• An inability to walk in a straight line and making the sufferer look drunk.
• Losing consciousness.
• Mental confusion.
• Liquid sounds in the lungs.
• Difficulty breathing.
• Rapid breathing or feeling breathless at rest.
• Coughing clear fluid, pink phlegm or blood (a very bad sign).
• Marked blueness of face and lips.
• High resting heartbeat (over 130 beats per minute)
• Mild symptoms rapidly getting worse.

High Altitude Cerebral Edema (HACE), dangerous cases of AMS

If, the above mentioned symptoms get worse and s/he could not take any precautions, one can die within the period of 12 hours, but if one takes precautions immediately, it takes one or two days to get well. Therefore, if one gets such symptoms, it is better one take treatment with medication, oxygen and descent down. Usually 4 to 8mg of dexamethasone is given as a first dose to those who suffer from such sickness and then 4mg Diamox is given an every six hours gap. Similarly, 2-4 litres/minute oxygen is given and one is taken to down if it is necessary.

High Altitude Pulmonary Edema (HAPE)

This is a serious case, if one gets the above mention symptoms worse, furthermore, if one accumulates of fluid in the lungs and mild fever, and then, there is chance of High Altitude Pulmonary Edema (HAPE). The treatment, one is give the oxygen at the rate of 4 liters a minute, using Portable Altitude Chamber (PAC). If there is no PAC bag or oxygen then one is taken down to the low altitude, it is only the way of life saving. the HAPE can also lead to unconsciousness are death in short period of time.

Prevention of Acute Mountain Sickness (AMS)

• Make sufficient time for acclimatization (After 3000 meters).
• Don't ascent up rapidly.
• Don't' use alcohol, sleeping pills and smoking.
• Drink more fluid 3-4 liters a day, clean boiled water / tea / coffee / soup / juice etc.
• Climb high and sleep low.
• Don't go trekking alone, take guide/porter.
• Follow the advice from your guide, hotel, local people, guide book.
• Descent if mild symptoms rapidly getting worse.
• Never leave or descent sick person along.
• Avoid getting cold.
• Take an easy and comfortable trekking route even if its longer.
• Sleep more than normal..

Causes of AMS, Symptoms and Treatment 

Causes of Altitude sickness and treatment

How to prevent altitude sickness during Nepal trekking ?

• Walk the talk

Climb slowly; this gives your body time to acclimatize. Walk at conversation pace and breathe normally. No need to worry if you are behind, we have extra staff who will accompany you on the trial. Nobody cares who is first!

• Climb high/ Sleep low

Sleep at the lowest possible altitude. This gives your body time to recuperate and adjust. We designed our trek so that you walk high and sleep at a lower altitude. For example, with areas above Namche Bazaar, we gain altitude during the day and return to lower altitude in the evening for overnight sleep.

• Push the fluids

Stay hydrated; drink plenty of water. We encourage clients to drink 5 liters of fluid or more. We are the first in the travel industry who practice sustainable tourism, with proper boiled water. (we have a water man)

• No alcohol

Avoid alcohol; there will be plenty of time to indulge when you return to lower altitudes!

• Know yourself

Have you had altitude sickness before? If so, you have a higher risk of having it again. Consult your doctor. Be aware of diamox, it can unmask other symptoms.

• Train at home

I recently had 3 brothers from Salt Lake City who successfully completed the EBC trek in 10 days. They hiked regularly at  home around 9,000 ft. (2743 meters) and above for many weeks. I believe training at home routinely makes it easier and faster to acclimatize into the thin air. Although altitude sickness can even affect anyone even a fit trekker. Altitude illness does not discriminate!

• Be honest

If you suffer AMS on the trail, please report to your guide. Don’t try to hide it or “tough it up”. It happens to everyone, even Sherpa returning home from a lower elevation. This careless act can result in an emergency evacuation or death in some cases.

• Acetazolamide or Diamox

Of all the medicinal products use to aid altitude acclimatization and treat altitude sickness the most popular is Diamox, whose active substance is Acetazolamide. On the Everest Base Camp trek Diamox is widely on sale without prescription in Kathmandu, Lukla and Namche Bazaar. One strip of Diamox contains 10 x 250 mg tablets and in Nepal you can buy it for 150 – 200 rupees.

Possible alternative names (trademarks) for Acetazolamide include: Acetamox, Acetazolam, Ak-Zol, Apo-Acetazolamide, Atenezol, Cidamex, Dazamide, Defiltran, Dehydratin, Diacarb, Diakarb, Diamox, Didoc, Diluran, Diuramid, Diureticum-Holzinger, Diuriwas, Diutazol, Donmox, Duiramid, Edemox, Eumicton, Fonurit, Glaupax, Glupax, Natrionex, Nephramid, Nephramide, Phonurit, Storzolamide, and Vetamox.

Before trekking it is advisable to start using Diamox 24 hours before your ascent and once you’ve started trekking you should use Diamox twice a day in doses of 125 – 250 mg depending on your body weight in the late morning and in the evening. Kids should be administered a Diamox dose of 2.5 mg per kg of body weight twice a day. It’s important to take Diamox before going to bed, because it deepens the depth of inhalation during sleep, thus improving the body’s supply of oxygen. Diamox is an effective means of preventing pulmonary oedema.

It’s true that Diamox can cause some side effects of which the most common are light tingling of the hands and finger tips, blurred vision, etc. Diamox can also induce allergic reactions; therefore it is recommended that you consult your doctor before use. According to some sources, you should stop taking Diamox on the second or third day after reaching the maximum height on your trekking route, while others say that it is not recommended to use Diamox for longer than 3 -5 days in a row. Based on my own experience during the Everest Base Camp trek, I would recommend starting to think about using Diamox upon reaching Namche Bazaar (3,440 m).

• Garlic soup

One of the best natural recipes for aiding altitude acclimatization that is often recommended by trekking guides in Nepal is garlic and the popular garlic soup served in Nepal’s trekking lodges and teahouses. At first it is likely to taste quite strange, but as you get used to it – you’ll begin to get a taste for it. Garlic soup is also widely available along the Everest Base Camp trek route.