High altitude illness and prevention

While reading "No Shortcuts to the Top: Climbing the World's 14 Highest Peaks" by Ed Viesturs, it was disheartening to revisit the 1996 Everest tragedy. High-altitude mountaineering will forever be linked with dangers, and all we can ever do is to minimise the chances of high altitude sickness and accidents.

Going up is optional, coming down is mandatory - Ed Viesturs.

I met a lot of climbers in Ladakh this season embarking on their first 6,000m expedition or attempting multiple ones. However, many of them appeared to lack awareness regarding the severe risks of high altitude illnesses beyond AMS and the necessary medication for prevention and treatment. As a result, I decided to pen down a brief post outlining the most prevalent illnesses and preventive measures that could benefit climbers and tourists in high altitude places.

High altitude sickness

Acclimatization

The process with which your body acclimatises to a change in the altitude around you, most notable after 3,000m. This is the most important step in order to avoid high altitude sickness before moving to higher altitudes.

The first 3-5 days in how your body responds to the altitude are the most crucial.

Avoid physical exertion in the first 48 hours of arrival, avoid alcohol and consider using acetazolamide (Diamox) to aid your acclimatization process in case an abrupt ascent is unavoidable.

High Altitude Illness and Prevention

There are primarily 3 syndromes of altitude illness: acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE).

A 4th symptom could be a high-altitude headache, which is the most common of the lot but it should be considered separately from AMS. Almost 50% of the climbers I climbed with this year experienced a headache, so its safe to say that its fairly common in high altitude climbing.

Acute Mountain Sickness (AMS)

AMS is the most common form of altitude illness. The symptoms are similar to an alcohol hangover, the most common being a headache followed by one or more of the following: loss of appetite, fatigue, nausea, dizziness or occasionally, vomiting.

Treatment

Providing bottled oxygen can give immediate relief to the person suffering from AMS. Ibuprofen can be used in case there's only a headache and no other symptoms. Acetazolamide (Diamox) is highly effective in treating AMS symptoms as it speeds acclimatization. Dexamethasone is more effective than acetazolamide at rapidly relieving the symptoms of moderate to severe AMS but it should be used sparingly. Staying at the current altitude should help resolve AMS symptoms in 12-48 hours, and if not, a steady descent to lower altitude is recommended.

High-Altitude Cerebral Edema (HACE)

Scott Fischer, the renowned American mountaineer, was a highly skilled climber who tragically lost his life on Everest during the 1996 disaster. It is speculated that Scott was experiencing HACE while descending from the summit, as he repeatedly expressed a desire to "jump off" to the lower camps to his sherpa.

Unlike AMS, HACE presents with neurological findings, particularly altered mental status, ataxia, confusion, and drowsiness, similar to alcohol intoxication.

Treatment

In remote areas, initiate descent immediately. Supplemental oxygen and dexamethasone can be life saving. Coma is likely to ensue within 12-24 hours in the absence of treatment or descent.

High-Altitude Pulmonary Edema (HAPE)

During my initial 6000m peak expedition in 2022, a friend of mine was climbing Mentok Kangri (6150m) nearby. Unbeknownst to him, he would not be able to advance beyond the base camp and had to return to the village of Karzok on a donkey due to suffering from HAPE. According to the doctors, 2% of his lungs were impacted, and he struggled to walk from his bed to the bathroom for two days.

HAPE can be more rapidly fatal than HACE. Initial symptoms include chest congestion, cough, exaggerated dyspnea on exertion, and decreased exercise performance. If unrecognized and untreated, HAPE progresses to dyspnea at rest and frank respiratory distress, often with bloody sputum.

Treatment

In most circumstances, descent is urgent and mandatory. Administer oxygen, if available, and exert the patient as little as possible. If immediate descent is not an option, use of supplemental oxygen is critical. In field settings, where resources are limited and there is a lower margin for error, nifedipine can be used as an adjunct to descent or oxygen.

Listing the illness and the medication below:

• Acetazolamide - AMS treatment, HACE prevention

• Dexamethasone - AMS treatment, HACE prevention and treatment

• Nifedipine - HAPE prevention and treatment

Conclusion

The main point of writing this blog about altitude illness is not to eliminate the possibility of mild illness but to prevent death or evacuation.

Climbers and tourists can adhere to 3 rules to help prevent death or serious consequences from altitude illness:

• Know the early symptoms of altitude illness and be willing to acknowledge when symptoms are present. Carry the three medicines mentioned above and know when to use what.

• Never ascend to sleep at a higher elevation when experiencing symptoms of altitude illness, no matter how minor the symptoms seem.

• Descend if the symptoms become worse while resting at the same elevation.

All of the above information has been cross-verified from https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness

For the love of the outdoors 🖤

*Disclaimer: Please consult your health advisor regarding the use of the medication mentioned above and its potential side effects.