The Adventure Element - Article - Recognising Acute Mountain Sickness (AMS) or Altitude Sickness and how to help prevent it.

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Article - Recognising Acute Mountain Sickness (AMS) or Altitude Sickness and how to help prevent it.

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Altitude sickness is an issue faced by many adventurous travellers and it’s not just those climbing mountains like Kilimanjaro (5,895m) or Mount Elbrus (5,642m) or even the lower altitudes of Jebel Toubkal (4,167m), as you might expect. Altitude sickness, also known as Acute Mountain Sickness (AMS), can be encountered by anyone reaching heights of 2,500m and above.

So its even possible to feel the effects of altitude just flying in to Leh, India (3,500m) which is the starting town for our own Stok Kangri expedition.  Even some skiers in the Alps experience it when visiting some of the higher resorts.

It is therefore important that all travellers are aware of Acute Mountain Sickness or Altitude Sickness and the potential consequences of not recognising and treating symptoms before they develop into anything more serious. While most cases are mild and perfectly manageable, some cases (especially those above 3,500m) can develop into potentially life threatening conditions, so it is vital to recognise the symptoms and treat them promptly. 

SYMPTOMS OF ACUTE MOUNTAIN SICKNESS (AMS):

  • Headaches
  • Shortness of breath
  • Decreased energy levels
  • Dizziness
  • Nausea and vomiting 
  • Diarrhoea
  • Loss of appetite
  • Trouble Sleeping

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 SYMPTOMS OF SEVERE ALTITUDE SICKNESS:

  • Worsening of mild symptoms
  • Confusion and irrational behaviour
  • Uncontrollable coughing
  • Weakness or decreased exercise performance
  • Blurred vision
  • Hallucinations
  • Coughing up fluid with possible blood stains
  • Convulsions
  • The appearance of being drunk and staggering

Strangely, there is no way to predict who might develop altitude sickness. A seasoned climber / trekker is just as likely to develop it as someone who has never been at altitude before.

There is no correlation between level of fitness and the chance of developing altitude sickness – even the fittest and healthiest of individuals may suffer. And don't be fooled into a false sense of security – just because you have not developed altitude sickness before, doesn’t mean you won’t in the future. 

PREVENTION
There are a number of things you can do to reduce your chances of developing altitude sickness such as:

  • Ascending slowly and taking time to acclimatise is vital. It is recommended to ascend no more than 300m-500m a day, particularly when above 3,000m
  • Take things slowly!!! Go slow and then go slower still. If you are getting out of breath, you're working too hard.
  • Keep yourself well hydrated with water and avoid alcohol. Water in-take should greatly increase with altitude
  • Make sure you keep your energy levels up by eating a high calorie diet
  • Use normal pain relief. i.e. Paracetamol and Ibrupofen
  • Medication (see below) 

MEDICATION
There are numerous medications available, including herbal remedies, that are aimed at preventing altitude sickness or reducing symptoms. Only one of these medications, acetazolamide (commonly known as Diamox), has been proven to be safe and effective. This is prescription-only medication so you’ll need to visit a travel clinic prior to your trip to obtain it.

Altitude sickness causes chemical changes in the blood and diamox works by balancing these chemical changes, which in turn reduces symptoms. Unfortunately, as with every medication, diamox has side effects.

  • The increased need to urinate
  • Tingling in the hands and feet
  • Carbonated drinks can taste metalic

Tingling sensations can also be a sign of frostbite, so keep your hands and feet wrapped up warmer if trekking in colder climates and check them regularly if you are experiencing this. It is also important not to stop drinking due to the increased need to urinate. When climbing at altitute it is important to stay hydrated.

TREATMENT
Mild altitude sickness can be managed by treating the symptoms. Basic painkillers such as paracetamol or ibuprofen can help alleviate headaches, while anti-sickness tablets can help reduce nausea and vomiting. Diamox can also be used to treat altitude sickness if it is not already being taken as a preventative method. Consult your pharmacy to discuss doses for both prevention and treatment.

If you have developed mild altitude sickness you should not progress to a higher altitude until your symptoms have been adequately managed. If you find your symptoms are getting progressively worse and not improving with treatment, you must discuss this with your expedition leader who may enforce you descend immediately before the condition becomes more serious.

We carry an extensive medical kit which has lots of prescription medications to assist in treating altitude related illnesses. However, there may only be one treatment and that is.....descend, descend, descend.

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CASE STUDY - Anna
Anna suffered from altitude sickness on a 7-day ascent of Stok Kangri. The first thing she noticed was that her energy levels decreased rapidly. Walking at a slow pace was difficult – she was left breathless. She developed a headache and felt very queasy in the stomach.

Her heartbeat was much faster than usual and she had spells of dizziness. She was vomiting too and was stuggling to walk as the effort was too much. She was given ibuprofen and anti-sickness medication, her bag was taken from her to lighten her load and the effort. Knowing she was nearly in camp, she went straight to bed on arrival to rest with food taken to her. Thankfully, after monitoring her condition over night,  the symptoms subsided and she was able to continue the climb.

Luckily for Anna, her case of altitude sickness was mild and manageable. In some cases it can develop into one of two potentially life-threatening conditions: High Altitude Pulmonary Oedema (HAPE) or High Altitude Cerebral Oedema (HACE) – or they can develop together. HAPE is when the lack of oxygen at high altitude causes a build-up of fluid in the lungs; HACE is the lack of oxygen causing a build-up of fluid in the brain. Both can lead to a loss of consciousness and death within hours.

The symptoms of HAPE are breathlessness even when you are resting, a high temperature and coughing up frothy spit. Symptoms of HACE are confusion and stumbling and uncharacteristic behaviour such as laziness, excessive emotion or violence. Oxygen can buy time and Diamox should be given if available but immediate descent is essential. 

TO CONCLUDE
Altitude related sicknesses can not be predicted apart from the mild syptoms which we will all feel. there is very little need to worry about them. Knowing the symptoms and being forwarned will help you relax.

The advice is simple: ascend slowly, use preventative medication if needed, stay hydrated and treat symptoms as soon as they occur. If you feel you're getting worse, it's time to accept that you may have to descend. Always discuss your condition with your expedition leader and be honest with them and yourself!

 

Friday 15th of December 2017

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