NEPAL>> HIGH ALTITUDE TREKKING & CLIMBING

Altitude sickness- The pleasures of trekking in the world's highest mountain ranges cannot be overstated. Neither can the dangers. A mixture (syndrome) of problems like headache, Nausea, shortness of breathe, tiredness encountered at high altitude i.e. above 8000ft. Cause / Factor of Altitude Sickness.Altitude sickness can occur in some people as low as 8,000 feet, but serious symptoms do not usually occur until over 12,000 feet. Even then it is not the height that is important, rather the speed in which you ascended to that altitude.

Acute mountain sickness (AMS) is actually more common in fit young men because they are more likely to attempt a rapid ascent by racing up the mountain like some indestructible super hero! As a general rule, it is far safer (and more enjoyable) to avoid altitude sickness by planning a sensible itinerary that allows for gradual acclimatisation to altitude as you ascend, (you can race back down as fast as you like!)

 

What is High Altitude Sickness?

It is difficult to determine who may be affected by altitude sickness since there are no specific factors such as age, sex, or physical condition that correlate with susceptibility. Some people get it and some people don't because some people are more susceptible than others.

Most people can ascend to 2,500 metres (8,000 feet) with little or no effect. If you have been at that altitude before with no problem, you can probably return to that altitude without problems as long as you are properly acclimatised.

 

If you haven't been to high altitude before, you should exercise caution when doing so.

 

A/ Less Oxygen
B/ Low Pressure i.e. Barometric Pressure
C/ Rapid Ascent
D/ Possibly Dehydration
E/ Hypothermia

 

Type of Altitude Sickness:
A/ AMS: - Acute mountain Sickness
B/ HAPE: - High Altitude Pulmonary Edema
C/ HACE: - High Altitude Cerebral Edema

 

Symptoms of Altitude Sickness:
A/ Acute Mountain Sickness - AMS
Mild symptoms feel like hangover / not feeling well
Headache
Fatigue/Tiredness
Nausea
Shortness of breath
Loss of appetite
Sleep Disturbance
Dizziness
B/ High Altitude Pulmonary Edema (water in the Lung) - HAPE

Increasing shortness of breath at rest
Severe cough- Dry /Productive
Very tired – Unusual fatigue while walking
High pulse rate i.e. 110
Blueness of face, lip, finger nails – that means inability to transport Oxygen into the blood
It can happen after 2 nights of arrival in the altitude.
C/ High Altitude Cerebral Edema (water in the Head) - HACE

 

Severe symptoms of Altitude Sickness
Severe Headache
Vomiting
Walking like a drunk (Ataxia)
Mental confusion/Altered mental status
Irritable – Does not want to be bothered by other people.
Unconsciousness or Coma.
Test: Tandem walking test, Hell to toe step. Fall off from the line.

In addition, the lower air pressure at high altitude can cause fluids to leak from the capillaries in both the lungs and the brain which can lead to a fluid build-up. Continuing on to higher altitude without proper acclimatisation can lead to the potentially serious, even life-threatening altitude sickness.

Acute Mountain Sickness (AMS)

AMS is very common at high altitude. At over 3,000 metres (10,000 feet) 75% of people will have mild symptoms. The occurrence of AMS is dependent upon the elevation, the rate of ascent, and individual susceptibility. Many people will experience mild AMS during the acclimatisation process. The symptoms usually start 12 to 24 hours after arrival at altitude and begin to decrease in severity around the third day.

 

The symptoms of Mild AMS include:

Headache
Nausea & Dizziness
Loss of appetite
Fatigue
Shortness of breath
Disturbed sleep
General feeling of malaise

Symptoms tend to be worse at night and when respiratory drive is decreased. Mild AMS does not interfere with normal activity and symptoms generally subside within two to four days as the body acclimatises. As long as symptoms are mild, and only a nuisance, ascent can continue at a moderate rate. When hiking, it is essential that you communicate any symptoms of illness immediately to others on your trip.

DECISION MAKING:
Find out the problem i.e. at altitude assume all problems are altitude sickness unless proven otherwise. If it is altitude problem with mild symptoms, stay at the same Altitude until the symptoms gone. E.g. Take an Aspirin, try to go up but listen to your body. If symptoms are worsening, go down.

 

Some basis guideline for the prevention of High Altitude sickness :

1. If possible, don't fly or drive to high altitude. Start below 3,000 metres (10,000 feet) and walk up.If you do fly or drive, do not overexert yourself or move higher for the first 24 hours.If you go above 3,000 metres (10,000 feet), only increase your altitude by 300 metres (1,000 feet) per day, and for every 900 metres (3,000 feet) of elevation gained, take a rest day to acclimatise.
2. Climb high and sleep low! You can climb more than 300 metres (1,000 feet) in a day as long as you come back down and sleep at a lower altitude.
3. If you begin to show symptoms of moderate altitude sickness, don't go higher until symptoms decrease.
4. If symptoms increase, go down, down, down!
5. Keep in mind that different people will acclimatise at different rates. Make sure everyone in your party is properly acclimatised before going any higher.
6. Stay properly hydrated. Acclimatisation is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least four to six litres per day). Urine output should be copious and clear to pale yellow.
7.Take it easy and don't overexert yourself when you first get up to altitude. But, light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
8. Avoid tobacco, alcohol and other depressant drugs including, barbiturates, tranquillisers, sleeping pills and opiates such as dihydrocodeine. These further decrease the respiratory drive during sleep resulting in a worsening of symptoms.
9. Eat a high calorie diet while at altitude.
10. Remember: Acclimatisation is inhibited by overexertion, dehydration, and alcohol.

1. If possible, don't fly or drive to high altitude. Start below 3,000 metres (10,000 feet) and walk up.If you do fly or drive, do not overexert yourself or move higher for the first 24 hours.If you go above 3,000 metres (10,000 feet), only increase your altitude by 300 metres (1,000 feet) per day, and for every 900 metres (3,000 feet) of elevation gained, take a rest day to acclimatise.
2. Climb high and sleep low! You can climb more than 300 metres (1,000 feet) in a day as long as you come back down and sleep at a lower altitude.
3. If you begin to show symptoms of moderate altitude sickness, don't go higher until symptoms decrease.
4. If symptoms increase, go down, down, down!
5. Keep in mind that different people will acclimatise at different rates. Make sure everyone in your party is properly acclimatised before going any higher.
6. Stay properly hydrated. Acclimatisation is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least four to six litres per day). Urine output should be copious and clear to pale yellow.
7.Take it easy and don't overexert yourself when you first get up to altitude. But, light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
8. Avoid tobacco, alcohol and other depressant drugs including, barbiturates, tranquillisers, sleeping pills and opiates such as dihydrocodeine. These further decrease the respiratory drive during sleep resulting in a worsening of symptoms.
9. Eat a high calorie diet while at altitude.
10. Remember: Acclimatisation is inhibited by overexertion, dehydration, and alcohol.

 

Note-Ascending slowly is the best way to avoid altitude sickness. Avoiding strenuous activity such as skiing, hiking, etc. in the first 24 hours at high altitude reduces the symptoms of AMS. As alcohol tends to cause dehydration, which exacerbates AMS, avoiding alcohol consumption in the first 24-hours at a higher altitude is optimal.