Coping with altitude in Nepal
Overwhelmed with medical advice and horror stories, trekkers can easily develop altitude paranoia. The fact is that just about everyone who treks over 4,000m experiences some mild symptoms of acute
mountain sickness (AMS), but serious cases are very rare, and the simple cure - descent - almost always brings immediate recovery.
AMS is apparent at high elevations not only because of less oxygen but also lower atmospheric pressure, which can have all sorts of strange effects on the body: it can cause the brain to swell, cause the lungs to fill with fluid, and even bring on uncontrollable flatulence! The syndrome varies from one person to the next, and strikes without regard for fitness - in fact, young people seem to be more susceptible, possibly because they try to push too hard or that they're more worried about admitting that they feel bad. Most people are capable of acclimatizing to very high elevations, but the process takes time and must be done in stages. The golden rule is
don't go too high too fast. Above 3,000m, the daily net elevation gain should be no more than around 500m; you should take mandatory acclimatization days at around 3,500m and 4, 500m - more if you are feeling unwell. These are built into our
Nepal trekking itineraries and
should not be ignored if you want to push on with the trek. Trekkers who fly directly to high airstrips have to be especially careful to acclimatize.
AMS usually gives plenty of warning before it becomes life-threatening. Mild symptoms include headaches, dizziness, insomnia, nausea, loss of appetite, shortness of breath and swelling of the hands and feet; one or two of these shouldn't be cause for panic, but they're a sign that your body hasn't adjusted to the elevation. You shouldn't ascend further until you start feeling better, or, if you do keep going, you should be prepared to beat a hasty retreat if the condition gets worse. Serious symptoms are persistent vomiting, delirium, loss of co-ordination, bubbly breathing and bloody sputum, rapid heart rate or breathlessness at rest, blueness of face and lips can develop within hours, and if ignored can result in death.
Symptoms of AMS:
| Mild | Moderate | Severe |
| Headache | Severe headache | Altered |
| Nausea | Vomiting | Consciousness |
| Malaise | Dizziness | Poor judgment |
| Low appetite | Irritability | Shortness of breath |
| Sleeplessness | Dry cough | Wet cough |
| Little urination | Coughing blood |
| | Unable to walk |
The only effective cure for advanced AMS is descent. Anyone showing serious symptoms should be taken downhill immediately, regardless of the time of day or night. Recovery is often dramatic, often after a
descent of only a few hundred vertical metres. Drink plenty of liquids at altitude - the body tends to retain water, and the air is incredibly dry. The usual adage is that you're not drinking enough unless you pee clear. Keeping warm, eating well, getting plenty of sleep and avoiding alcohol will also help reduce the chances of getting AMS.
If AMS symptoms are moderate or severe, or mild symptoms are getting worse, acetazolamide (Diamox) treatment may be useful. The dose is up to 250 mg every 12 hours. Acetazolamide stimulates breathing and therefore helps the body get more oxygen. In particular it helps you breathe better at night and therefore aids sleep without causing any sedating effects. Possible side effects of acetazolamide include tingling in the hands, toes or lips, increased urination, and a noticeable change in the taste of carbonated beverages. Generally these symptoms are merely annoyances, and will cease when the drug is stopped. Travellers who have allergies to sulfa antibiotics and have never used acetazolamide should not use this medicine, as acetazolamide is a sulfa derivative; there is a slight possibility of allergic cross reaction.
As well as acting to treat symptoms of AMS, acetazolamide can also help prevent or decrease severity of AMS symptoms before they occur. When trekking on one of Nepal's higher altitude treks, like the 18-day
Everest Base Camp Trek, it is not unreasonable to take 125 - 250 mg of acetazolamide 2 times per day 24 hours before ascending to high altitude to help prevent the symptoms of AMS.
© Copyright Nepal Uncovered tours, the specialist Nepal cultural and adventure tour operator
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