Altitude Sickness

Altitude sickness (also known as acute mountain sickness) commonly occurs in climbers that reach a high altitude too quickly without time to adjust to the new environment. As altitude increases the atmospheric pressure decreases, meaning there is decreasing levels of oxygen in the air you breathe. This decrease in the amount of oxygen you are breathing in causes the symptoms of altitude sickness including headache, nausea, dizziness and exhaustion.

Altitude sickness is common amongst climbers and skiers who spend time at 2,500m (8,000 feet) above sea level. Symptoms tend to get more severe at altitudes of 3,600m (12,000 feet) or more. There is no specific demographic that is more likely to develop altitude sickness than others; it is not affected by age, sex, fitness or weight. Some people are more susceptible to getting altitude sickness than others, and it does not mean you will experience it in the future because you have had it previously.

At altitudes of 2,500m (8,000 feet) or higher, the symptoms of altitude sickness can appear within 6 to 24 hours if you have ascended the mountain too quickly.

The symptoms of mild altitude sickness include:

• Headache
• Nausea/vomiting
• Dizziness/feeling unsteady
• Tiredness
• Loss of appetite
• Upset stomach
• Shortness of breath
• Increased heart rate
• Difficulty sleeping

There will usually be a general feeling of being unwell, like having a bad hangover. Normally the symptoms of altitude sickness are worse at night.

In more severe cases of altitude sickness the following symptoms may occur:

• Persistent, irritable cough
• Breathlessness
• Bubbling sound in the chest
• Coughing up pink/white frothy liquid
• Difficulty walking/clumsiness
• Irrational behavior
• Double vision
• Drowsiness
• Confusion
• Convulsions/fits

In addition to these symptoms, there may be a worsening of the symptoms of mild altitude sickness above. Severe symptoms of altitude sickness can be a sign of cerebral or pulmonary oedema (excess fluid in the skull/lungs) and is a medical emergency. You should descend immediately and seek professional medical treatment.

Altitude sickness is normally self-diagnosed, or diagnosed by a peer, based your symptoms. If there is a medical professional on your trip, they will be able to diagnose altitude sickness and give advice on its treatment.

Before travelling you should always familiarise yourself with the symptoms of Altitude Sickess to allow you to quickly recognise them in yourself or others. Fast response and treatment of Altitude Sickness is extremely important to reduce any danger associated with the condition.

Remember: if you experience or suspect severe symptoms of altitude sickness, you should descend with a partner and seek immediate medical treatment.

Halt your ascent or decend up to 500m 

If you are experiencing symptoms of mild altitude sickness, do not ascend any further for at least 24 to 48 hours, until your symptoms have cleared. You may wish to descend up to 500m to help ease symptoms and speed up acclimatisation. If the symptoms of mild altitude sickness do not go away after 48 hours you need to descend by at least 500m (1,600 feet) and do not climb again until the have completely disappeared.

To aid acclimatisation and ease symptoms of mild altitude sickness:

• Do not exercise
• Keep hydrated
• Avoid alcohol
• Do not smoke
• Do not use sleeping pills
• Eat a high-calorie diet
• Rest as much as possible

Always ensure you tell your group how you are feeling so they can be aware to look out for symptoms of severe altitude sickness.

Oxygen treatment can be helpful to ease symptoms of altitude sickness to allow you to descend and acclimatise. Oxygen treatment is not a replacement for descending and acclimatising.

Paracetamol or ibuprofen can be used to treat pain or discomfort from headaches caused by mild altitude sickness.

Promethazine (Phenergan) tablets can be used to treat nausea and sickness associated with mild altitude sickness. Promethazine is an antihistamine that also acts as anti-emetic (it stops nausea & vomiting).

Diamox (Acetazolamide)

Diamox (acetazolamide) can help to both ease the symptoms of, and prevent, mild altitude sickness. It helps to correct the chemical imbalance in your brain caused at high altitudes. Diamox can help to reduce the recovery time from mild altitude sickness from 24-48 hours to 12-24 hours, provided you do not ascend further in this time.

Diamox can also help to prevent altitude sickness in people who are ascending quickly without time to properly acclimatise. There is still however, the risk of serious altitude sickness if you do not properly acclimatise, which can result in a medical emergency. Rapid ascent is not recommended.

Diamox can occasionally cause mild side effects. These can include slight numbness or tingling in the face, fingers or toes, some loss of appetite, taste disturbance, flushing, thirst, headache, dizziness, fatigue, and irritability. Most doctors suggest taking a trial dose of Diamox for a couple of days before your trip to ensure you do not suffer any adverse reactions (this is normally half a tablet daily for 2-4 days).

Remember, even in those taking Diamox, it is still important to properly acclimatise. You should never ascend further until your symptoms have completely gone and you are properly acclimatized to your current altitude. Do not use Diamox to push through the symptoms of altitude sickness and continue to climb, this is extremely dangerous and can be fatal.

The most effective way to prevent altitude sickness at altitudes of 2,500m and above is proper acclimatisation. Climbing slowly will give your body proper chance to adapt to the changes in oxygen levels at high altitudes.

Rules to follow for proper acclimatisation:

• Ascend slowly with overnight stops at regular intervals
• Try to plan for days to acclimatise in your itinerary
• If you are ascending over 3,000m (10,000 feet) you should spend at least one night at an intermediate level (1,500 – 2,000m) for a night before you start to ascend above 3,000m.
• When ascending above 3,000m, only ascend 300-500m a day to each new overnight stop.
• If more than a 500m ascent is necessary in a day, after the ascent you should descend back down so you are 500m or less from your original starting point that day. Your net increase in altitude should not be more than 500m without an overnight sleep stop.
• For every 1,000m (3,000 feet) of ascent height, you should have 2 nights of sleep before going higher.

For walking or trekking holidays that involve climbing low peaks or crossing ridges but sleeping in valleys, altitude sickness is unlikely to be a problem. On skiing holidays where you are staying in a valley or sleeping at heights of 3,000m (10,000 feet) or less, altitude sickness is unlikely to be a problem. On climbing holidays where you will ascend to over 3,500m (12,000 feet) such as higher peaks in the Alps, Kilimanjaro and the Colorado Rockies, a few days spent climbing lower peaks to acclimatise is recommended.

Diamox (acetazolamide) can also be taken two days before, during your ascent and for one day after to help prevent altitude sickness.

For further information on proper acclimatisation techniques, see the 'How is Altitude Sickness Treated?' section above.

 Alternative measures to take if Acetazolamide is not available: 

• Keep hydrated
• Avoid Alcohol
• Do not smoke 
• Do not use sleeping pills
• Consume a high high-calorie diet
• Rest as much as possible

If you are experiencing symptoms of mild altitude sickness, do not ascend any further for at least 24 to 48 hours, until your symptoms have cleared. You may wish to descend up to 500m to help ease symptoms and speed up acclimatisation.