High Altitude Sickness

Oxygen Level In Everest

AMS, HACE, and HAPE are serious medical conditions that can happen when ascending to high altitudes too quickly.
AMS is the mildest form, with symptoms like headache, fatigue, dizziness, and nausea.
HACE involves fluid buildup in the brain with severe symptoms like confusion and loss of coordination.
HAPE involves fluid accumulation in the lungs causing shortness of breath and chest tightness.
​These conditions are more likely in non-acclimatized individuals ascending rapidly. Proper acclimatization, hydration, and descending to lower altitudes are essential for prevention and treatment. Severe cases may require oxygen therapy or descent.

What is High altitude ?

High altitude refers to locations that are situated at a higher elevation above sea level. Generally, high altitude is considered to be any elevation above 2,500 meters. At high altitudes, the air is thinner, and there is less oxygen available, which can cause symptoms such as shortness of breath, headaches, fatigue, and difficulty sleeping. People who are not used to high altitudes may experience altitude sickness, which can range from mild symptoms to more severe conditions like pulmonary edema or cerebral edema. It is important to acclimatize properly when traveling to high altitude locations to avoid these issues.

What is High altitude sickness ?

High-altitude sickness, also known as altitude sickness or acute mountain sickness (AMS), is a condition that can occur when you ascend to high elevations too quickly. It typically occurs at altitudes above 2,500 meters (8,200 feet). The primary cause is the decrease in air pressure and lower oxygen levels at higher altitudes.
Symptoms of high-altitude sickness may include headaches, nausea, dizziness, fatigue, and difficulty sleeping. In severe cases, it can lead to more serious conditions like high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE), which can be life-threatening.
To prevent high-altitude sickness, it's recommended to acclimatize gradually, stay hydrated, avoid alcohol and tobacco, and pay attention to your body's signals. If symptoms persist or worsen, descending to a lower altitude is crucial for recovery.
Given your association with Big Sky Treks Nepal, it's important to be well-informed about high-altitude sickness, especially when organizing trekking or mountaineering expeditions in the Himalayan region where altitudes can be significant.
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Causes of Altitude Sickness

Altitude sickness is primarily caused by reduced air pressure and lower oxygen levels at higher elevations. The main factors contributing to its development include rapid ascent without acclimatization, individual susceptibility, higher altitudes above 2,500 meters, dehydration, physical exertion, pre-existing respiratory conditions, and improper sleeping altitude. To prevent altitude sickness, one should ascend gradually, stay hydrated, avoid excessive exertion, and monitor symptoms closely. Descending to a lower altitude is crucial if symptoms develop, and severe cases require immediate medical attention.
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• Rapid Ascent and Lack of Acclimatization: Ascending to high altitudes too quickly without allowing the body enough time to acclimate is a significant risk factor for altitude sickness. Gradual ascent, allowing the body time to adjust to the lower oxygen levels, is crucial to prevent and minimize symptoms. Rapid ascent can lead to inadequate oxygen saturation in the blood, triggering altitude sickness.
• Individual Susceptibility: Some individuals are more prone to altitude sickness than others, and it's challenging to predict who will be affected. Factors such as age, fitness level, and previous experiences with altitude can influence susceptibility. Individuals with a history of altitude sickness are more likely to experience it again.
• Higher Altitude: Altitude sickness is more common above 2,500 meters, and severe cases are often seen at elevations above 3,500 meters. The risk of altitude sickness increases with higher altitudes due to the decreased oxygen availability in the air.
• Dehydration and Fluid Loss: Inadequate fluid intake can exacerbate the symptoms of altitude sickness. At higher elevations, the body loses more fluids through increased respiratory rate and potential increased urine output. Staying well-hydrated is essential to prevent dehydration and support overall health at altitude.
• Physical Exertion: Strenuous physical activity, especially at high altitudes, can contribute to the development and severity of altitude sickness. Engaging in excessive physical exertion without sufficient acclimatization can strain the body and increase the risk of experiencing symptoms of altitude sickness.
• Respiratory Conditions: Pre-existing respiratory conditions, such as chronic obstructive pulmonary disease (COPD) or asthma, may increase the risk of altitude sickness. Individuals with underlying respiratory issues may have a harder time adjusting to the lower oxygen levels at high altitudes.
• Sleeping Altitude: Sleeping at a higher altitude than the one at which an individual has acclimatized can also contribute to the development of altitude sickness. Gradual progression in sleeping altitude along with proper acclimatization is important to reduce the risk of symptoms during sleep.
• Alcohol and medication use: Alcohol and certain medications can worsen altitude sickness symptoms by depressing the respiratory system. It is recommended to avoid these substances at high altitudes to reduce the risk of exacerbating altitude sickness.

It's important to be proactive in preventing altitude sickness by adhering to a gradual ascent, staying hydrated, avoiding excessive physical exertion, and monitoring symptoms closely. If symptoms of altitude sickness develop, descending to a lower altitude is the most effective treatment. Severe cases require immediate medical attention.
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​Symptoms of High Altitude Sickness 

​Altitude sickness, also known as acute mountain sickness (AMS), can manifest through various symptoms, some of which may include:

Altitude sickness, or acute mountain sickness (AMS), can present with symptoms including persistent headache, nausea, fatigue, dizziness, difficulty breathing, loss of appetite, insomnia, swelling, rapid heartbeat, and confusion. It is crucial to recognize these symptoms and take necessary actions like descending to lower altitudes, resting, staying hydrated, or seeking medical help if symptoms worsen. Gradual acclimatization is advised when ascending to higher altitudes to lower the risk of altitude sickness.

• Headache: A persistent, throbbing headache is one of the most common symptoms of altitude sickness.
• Nausea or vomiting: Feeling nauseous or experiencing vomiting can occur as a result of altitude sickness.
• Fatigue or weakness: Individuals may feel unusually tired or weak, even with minimal physical activity.
• Dizziness or lightheadedness: Feeling unsteady or dizzy, similar to the sensation of being lightheaded.
• Difficulty breathing: Shortness of breath or difficulty breathing, especially during physical exertion, can be a sign of altitude sickness.
• Loss of appetite: Reduced interest in eating or a diminished sense of hunger may be experienced.
• Insomnia: Difficulty sleeping or restless sleep patterns are common at higher altitudes.
• Swelling of hands, feet, or face: Fluid retention can lead to swelling in extremities or the face.
• Rapid heartbeat: An increased heart rate, even at rest, is another symptom of altitude sickness.
• Confusion or disorientation: In severe cases, individuals may experience confusion, difficulty concentrating, or a lack of coordination.

It is essential to recognize these symptoms and take appropriate steps, such as descending to a lower altitude, resting, staying hydrated, or seeking medical attention if symptoms worsen, to prevent further complications. It is recommended to acclimatize gradually when ascending to higher altitudes to reduce the risk of developing altitude sickness.

Treatment of High Altitude Sickness 

Treatment for altitude sickness depends on symptom severity and includes descending, resting, oxygen therapy, medication, or hyperbaric therapy. Seek medical help if symptoms worsen. Preventing altitude sickness involves gradual acclimation, hydration, and listening to your body.

• Descend to a lower altitude: The most effective treatment for altitude sickness is to descend to a lower altitude where there is more oxygen available. This can help alleviate symptoms quickly.
• Rest and hydrate: Resting and staying hydrated are important in managing altitude sickness. Avoid strenuous physical activity and drink plenty of fluids to help your body acclimatize.
• Oxygen therapy: In severe cases of altitude sickness, supplemental oxygen may be needed to increase oxygen levels in the blood and alleviate symptoms.
• Medications: Certain medications, such as acetazolamide (Diamox), may be prescribed to help alleviate symptoms of altitude sickness and promote acclimatization.
• Hyperbaric therapy: In extreme cases of high altitude sickness, hyperbaric therapy, which involves breathing in oxygen in a specially pressurized chamber, may be used to quickly increase oxygen levels in the blood.

It is important to seek medical attention if symptoms of altitude sickness worsen or if you develop more severe conditions such as high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE). In some cases, evacuation to a lower altitude may be necessary for proper treatment. Prevention is always the best approach when traveling to high altitudes, so it is recommended to acclimatize slowly, stay hydrated, and listen to your body's signals.
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Prevention of Altitude Sickness 

​Various preventive measures such as gradual acclimatization, hydration, nutrition, avoiding alcohol and tobacco, medication if necessary, physical fitness, avoiding rapid ascents, monitoring altitude and symptoms, rest and sleep, and descending if symptoms worsen aim to help the body adjust to high altitudes and reduce the risk of developing mountain sickness, ensuring a safe and enjoyable experience.

• Acclimatization: This involves gradually ascending to higher altitudes to allow your body to adjust to the reduced oxygen levels. It is essential to give your body time to adapt to the environmental changes to prevent mountain sickness.
• Hydration: Staying well-hydrated at high altitudes is crucial to prevent dehydration, which can exacerbate symptoms of mountain sickness. Drinking plenty of water helps maintain proper bodily functions and oxygen levels.
• Proper nutrition: Eating a balanced diet rich in essential nutrients supports overall health and helps your body cope with the challenges of high altitudes. Nutritious foods provide the energy required for physical exertion and altitude-related stress.
• Avoid alcohol and tobacco: Alcohol and tobacco can negatively impact your body's ability to acclimatize to high altitudes and increase the risk of developing mountain sickness. Avoiding these substances can help maintain your overall health at altitude.
• Medication: Some individuals may benefit from medications such as acetazolamide to prevent or alleviate symptoms of mountain sickness. It is important to consult with a healthcare provider before taking any medication to ensure it is safe and appropriate for you.
• Physical fitness: Being in good physical condition can help reduce the risk of developing mountain sickness. Engaging in regular exercise before a high-altitude trek can improve your overall health and fitness levels, making it easier for your body to adapt to the altitude.
• Avoid rapid ascents: Climbing too quickly to higher altitudes without allowing time for acclimatization can increase the risk of developing mountain sickness. It is essential to pace yourself and give your body the time it needs to adjust. Keep track of the altitude you are at and be mindful of any early symptoms of mountain sickness, such as headache, fatigue, or dizziness. Being aware of your altitude and how your body is reacting can help you take necessary precautions.
• Rest and sleep: Proper rest and quality sleep are essential for your body to recover and acclimatize to high altitudes. Ensuring you get enough rest can help prevent fatigue and reduce the risk of developing mountain sickness.
• Descend if necessary: If symptoms of mountain sickness become severe or do not improve with rest and hydration, it is crucial to descend to a lower altitude promptly. Descending can help alleviate symptoms and prevent the condition from worsening, ensuring your safety and well-being.

By following these preventive measures, you can reduce the risk of developing altitude sickness and enjoy a safer and more enjoyable experience at high altitudes.
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High Altitude Cerebral Edema (HACE)

High Altitude Cerebral Edema (HACE) is a severe and life-threatening form of altitude sickness that occurs when there is fluid accumulation in the brain at high altitudes. This condition is considered a medical emergency, and prompt treatment is crucial. Here are the causes and treatment for High Altitude Cerebral Edema:

Causes of HACE:

• Hypoxia: The primary cause of HACE is a lack of oxygen at high altitudes, which leads to hypoxia. The reduced oxygen levels can result in vasodilation (enlargement of blood vessels) and increased permeability of blood vessel walls in the brain.
• Individual Susceptibility: Some individuals may be more susceptible to HACE than others, and factors such as genetics, acclimatization, and overall health can play a role.

Symptoms of HACE:

• Severe headache
• Confusion or altered mental status
• Loss of coordination
• Nausea and vomiting
• Hallucinations
• Weakness or fatigue
• Coma (in severe cases)

Treatment of HACE:

• Immediate Descent: The most critical and effective treatment for HACE is immediate descent to a lower altitude. Every effort should be made to get the affected person to a lower elevation as quickly as possible.
• Supplemental Oxygen: Administering supplemental oxygen, if available, can help improve oxygen levels and alleviate symptoms temporarily. However, it does not replace the need for descent.
• Hyperbaric Chamber: In remote areas where immediate descent is not possible, the use of a portable hyperbaric chamber may be considered. This device simulates a lower altitude environment and can provide some relief while arranging for evacuation.
• Medical Attention: Seek immediate medical attention. HACE is a medical emergency, and professional medical care is essential for a proper diagnosis and treatment.

Prevention of HACE:

• Gradual Ascent: Allow for gradual acclimatization by ascending slowly and taking rest days.
• Stay Hydrated: Maintain proper hydration by drinking plenty of fluids.
• Avoid Alcohol and Tobacco: These substances can contribute to dehydration and worsen altitude-related conditions.
• Recognize Symptoms: Be aware of the symptoms of altitude sickness and HACE. If symptoms occur, descend immediately.
• Acetazolamide (Diamox): In some cases, preventive use of medication like acetazolamide may be recommended. Consult with a healthcare professional before using any medications.

​
It's crucial to recognize the symptoms of HACE and act promptly. Delaying treatment can lead to worsening symptoms and potential fatality. Prevention, including gradual acclimatization, proper hydration, and recognizing early signs of altitude sickness, is essential to reduce the risk of developing severe conditions like HACE.
​

High Altitude Pulmonary Edema (HAPE)

High Altitude Pulmonary Edema (HAPE) is a serious condition that occurs at high altitudes when there is a build-up of fluid in the lungs. Here are the causes, symptoms, treatment, and prevention measures for HAPE:

Causes of HAPE:

• Rapid Ascent: Ascending to high altitudes too quickly without proper acclimatization is a primary cause.
• Low Oxygen Levels: Reduced oxygen levels at higher altitudes can lead to constriction of blood vessels in the lungs, causing fluid leakage.

Symptoms of HAPE:

• Shortness of Breath: Difficulty breathing, especially during physical activity.
• Persistent Cough: A cough that may produce frothy or pink sputum.
• Chest Tightness or Pain: Discomfort in the chest, often described as tightness or pain.
• Bluish or Grayish Skin Color: This is a sign of severe oxygen deprivation.

Treatment of HAPE:

• Descent: Immediate descent to a lower altitude is crucial for treating HAPE. Descend at least 300-500 meters (about 1,000-1,600 feet) or more until symptoms improve.
• Supplemental Oxygen: Administering supplemental oxygen can help improve oxygen levels while descending.
• Portable Hyperbaric Chamber (Gamow Bag): In severe cases, where immediate descent is not possible, a portable hyperbaric chamber may be used to simulate a lower altitude and reduce symptoms.

Prevention of HAPE:

• Gradual Ascent: Allow for gradual acclimatization by ascending slowly and taking rest days.
• Stay Hydrated: Maintain proper hydration by drinking plenty of fluids.
• Avoid Overexertion: Limit strenuous physical activity during the initial days at higher altitudes.
• Recognize Symptoms: Be aware of the symptoms of altitude sickness and HAPE. If symptoms occur, descend immediately.
• Acetazolamide (Diamox): In some cases, preventive use of medication like acetazolamide may be recommended. Consult with a healthcare professional before using any medications.

​HAPE is a medical emergency, and immediate action is crucial. If you suspect someone has HAPE, seek medical help and initiate descent as quickly as possible.
It's important to emphasize that prevention and early recognition of symptoms are key in avoiding severe altitude-related conditions like HAPE. Always consult with healthcare professionals for personalized advice based on individual health conditions and travel plans.
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Oxygen Level according to Height in Meters 

Oxygen Level in Different Height

Source : ​https://milehightraining.com/wp-content/uploads/2019/08/milehightraining-Altitude-To-Oxygen-Chart002.jpg

Symptoms of AMS, HACE and HAPE ​

Oxygen Level in Percentage 

Oxygen Level in Percentage

What Happens Your body at High Altitude 

What Happens Your body at High Altitude

​All About Altitude sickness picture 

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Altitude sickness 

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 mention 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..