Altitude Sickness
Altitude sickness if a serious consideration if you are climbing or trekking in Nepal and it's essential that you investigate the causes, symptoms and treatment of altitude sickness before you travel to Nepal. There are approximately three deaths per year in Nepal from altitude sickness, but with the right precautions there is no reason why you should become one of these statistics.
Acclimatization's the word used to describe the adjustments your body makes as it ascends. You should adjust your schedule so that you average no more than 400 meters per day of ascent above 3,000 meters. If you fail to allow time for acclimatization, you may develop symptoms of Attitude mountaineering System. The AMS may be mild enough to go away with a day's rest or if ignored may lead to death. All that is required to ensure a safe trek is basic awareness of AMS, and a willingness to rest or descend if you develop symptoms. As a result of the growing awareness of altitude problems there is only one death from AMS in Nepal out of every 30,000 trekkers and climbers. Even these deaths would be avoidable if everyone knew how to respond to AMS. There are no reliable figures for casualties among porters. Recognizing Acute Mountain Sickness
What is Altitude Sickness?
- Altitude sickness occurs when someone has been unable to acclimatize to the point to which they have ascended. As ascent increases, then levels of oxygen decrease. It is asserted that there is half the amount of oxygen above 5000m like Everest Base camp, Annapurna Circuit as there is there is in the sea. During ascents in Nepal an individual will typically find that their breathing increases to account for the decrease in oxygen. This is a positive response by the body and seems to be genetic as individuals who are more prone to altitude sickness typically manifest this response less readily than those who are less prone to altitude sickness. Altitude sickness in Nepal (as elsewhere) happens when fluid collects in cells around the body as the result of failure to acclimatize. More severe forms of Altitude sickness occur when this fluid buildup subsequently builds up in the lungs and brain - the two most susceptible parts of the body.
What are the symptoms?
- The symptoms of Altitude sickness in Nepal are nausea, irritability, headaches, a dry cough and in more severe cases of Altitude sickness the victim may start to cough up a pink frothy substance and lose their balance as though drunk.
What is the prevention?
- It is essential that you give your body time to acclimatize as you ascend. If you fly into high altitudes during your trip to Nepal, then you should spend two to three nights at that place enjoying the local attractions and resting. This should give you time to acclimatize. You should take great note of your body at all times and if you feel the slightest of Altitude sickness symptoms then you should remain where you are until these have passed. As you ascend take frequent breaks at each 1000 meters and, again do not continue to ascend if you are feeling the slightest of Altitude sickness symptoms.
What is the treatment?
If you are experiencing Altitude sickness during your trip to Nepal then it is essential that you ascend immediately and do not attempt to climb again until your body has acclimatized.
Severe cases may need to be flown out, so ensure that you have adequate travel insurance during your Nepal trip
Three golden rules to avoid dying from altitude illness:
- Learn the early symptoms of altitude illness and recognize when you have them. Remember, you may be the only person in a group with symptoms.
- Never ascend to sleep at a new altitude with any symptoms of AMS.
- Descend if your symptoms are getting worse while resting at the same altitude.
Normal AMS Symptoms:
Should expect but not worry.
Following are the normal altitude symptoms that you should expect but not worry about. Every trekker will experience some or all of these, no matter how slowly they ascend.- Periods of sleeplessness
- Need more sleep than normal (often 10 hours or more)
- Occasional loss of appetite
- Vivid, wild dreams especially at around 2500-3800 meters in altitude
- Periodic breathing
- The need to rest/catch your breath frequently while trekking, especially above 3500 meters
- Runny nose
- Increasing urination while moving to/at higher altitudes (a good sign) Dizziness.
Mild AMS Symptoms - NEVER GO HIGHER:
Many trekkers in the high valleys of the Himalaya get mild AMS, admit or acknowledge that you are having symptoms. You need have only one of the following symptoms to be getting altitude sickness.- Mild headache.
- Nausea Dizziness
- Weakness
- Sleeplessness
- Dry Raspy cough
- Fatigue/Tired
- Loss of apatite
- Runny nose
- Hard to breath
Dangerous cases of AMS:
High Altitude Cerebral Edema (HACE) this is a build-up of fluid around the brain. It cases the first five symptoms on the mild and severe lists previously. Coma from HACE can lead to unconsciousness are death within 12 hours from the onset of symptoms, but normally takes 1-2 days to develop. At the first sign of ataxia begin treatment with medication, oxygen and descent. Usually 4 to 8mg of dexamethasone is given as a first does, then 4mg every six hours, Diamox every 12 hours and 2-4 liters /minute oxygen. Descent is necessary but a PAC (portable altitude chamber) bag will often be used first if available. High
Altitude Pulmonary Edema (HAPE):
This is an accumulation of fluid in the lungs and is very serious. It is responsible for all the other mild and serious symptoms and it is often accompanied by a mild fever. By far the treatment is oxygen at 4 liters a minute but using PAC (portable altitude chamber) bag treatment is a good substitute. If there is no PAC bag or oxygen then descent will be life saving. HAPE can lead to unconsciousness are death very quick.- Prevention of Acute Mountain Sickness (AMS)
- Allow sufficient time for acclimatization (After 3000 meters)
- Don’t make rapid Ascent. Don’t go too far too fast
- No Alcohol, Sleeping pills and Smoking
- Drink more fluid 3-4 Liters a day, clean water-boiled or treated / tea / coffee / soup / juice etc.
- Climb high and sleep low
- Do not trek/travel alone, take guide/porter
- Follow the advice from your guide, hotel, local, guide book
- Descent if mild symptoms rapidly getting worse.
- Never leave or descent sick person along.
- Avoid getting cold.
- Take easy and comfortable trekking rout even it is longer.
First Aid Kit:
This is the basic list to cover the more common ailments that afflict trekkers. Climbing group, expeditions and trekkers going to isolated areas will need a more comprehensive kit.
- Bandage for sprains
- Plasters/Band-aids
- Iodine or water filter (optional)
- Moleskin/Second skin - for blisters
- Antiseptic ointment for cuts
- Anti-bacterial throat lozenges (with antiseptic)
- Aspirin/Paracetamol - general painkiller
- Oral rehydration salts Broad-spectrum antibiotic (norfloxacin or ciprofloxin)
- Anti-diarrhea medication (antibiotic)
- Diarrhea stopper (Imodium - optional)
- Antibiotic for Guardia or similar microbe or bacteria
- Diamox 250/500mg (for altitude sickness - can be bought in Kathmandu)
- Sterile Syringe set (anti-AIDS precaution)
- Gel hand cleaner
Other treatment modalities to help during descent:
Diamox:-Diamox is generally useful for mild to moderate AMS. Dosage: One 250 mg tablet two or three times a day.
Dexamethasone: is a very potent steroid used in HACE temporarily to facilitate descent. This drug improves the symptoms but does not help acclimatization. It is not recommended to ascend while still taking this drug even if one is symptom free. Dosage: 4 mg every 6 hours.
Nifedipine : is useful in HAPE by lowering pressure in the pulmonary blood vessels and thereby decreasing fluid in the lungs. This drug also lowers blood pressure. Sildenafil (Viagra) is increasingly being used in treating HAPE.
Oxygen : is very useful particularly for HAPE.
