ACUTE MOUNTAIN SICKNESS (AMS)

Read to stay
safe at High Altitude


The most common illness associated with travel and altitude, is termed acute mountain sickness (AMS).  is quite similar to a hangover - it causes headache, nausea, and fatigue. This is very common: some people are only slightly affected, others feel awful. AMS is common at high altitudes, that is above 8,000 feet. Three-quarters of people have mild symptoms of AMS over 10,000 feet.

Many people who ascend to moderate or high altitudes experience the effects of acute altitude sickness. Symptoms of this sickness typically begin 6-48 hours after the altitude exposure begins, and include headache, nausea, lethargy, dizziness and disturbed sleep.

AMS or Altitude Sickness can be broadly divided into 2 categories- Mild and Severe, depending on the severity of the symptoms.

Mild Acute Mountain Sickness

If you have a mild case, you may experience:

  • Dizziness
  • Headache
  • Muscle aches
  • Nausea and vomiting
  • Swelling of the hands, feet, and face
  • Rapid heartbeat
  • Shortness of breath with physical exertion

Mild altitude mountain sickness is very common at high altitudes.  Generally, symptoms develop within 6–10 hours of ascending and tend to resolve as you acclimatise to the new altitude.

Severe Acute Mountain Sickness

Severe cases of acute mountain sickness can cause more intense symptoms and affect your heart, lungs, muscles, and nervous system.

  • Coughing
  • Chest congestion
  • Pale complexion and skin discoloration

Inability to walk or lack of balance

Always be on the look-out for AMS symptoms if travelling to high-altitude.

If symptoms worsen avoid further ascent, consider the possibility of altitude related illnesses and descend as necessary. Hiding illness or ignoring symptoms could be fatal.

Be honest with everyone about changes in your medical condition.

Acute Mountain Sickness Treatment

The definitive treatment for AMS is descent. First and foremost, upon beginning to feel ill at altitude, do not ascend any higher. Reduce your activity level and make sure you drink plenty of water and avoid alcohol. Dehydration is a contributing factor to altitude sickness. 

The best cure is either to acclimatize properly or descend.

Acute Mountain Sickness Medicine

There are several medicines available in the market for high altitude sickness. What they do is make your body breath faster than the usual rate and hence try to compensate for the low amount of oxygen. However even these medicine are a precautionary measure and not a cure. They become useless once you start feeling the symptoms and should be taken as a precaution to avoid symptoms.

Acetazolamide (Diamox)

The most commonly used medication is acetazolamide(trade name Diamox). This medication is used to both prevent and treat symptoms of AMS. Often taken as a 125mg tablet, twice per day, acetazolamide is effective at preventing AMS symptoms. Some people are allergic to Diamox. There are side effects, e.g. tingling, especially of hands, feet and face. Some people find this unpleasant, but it is not harmful and will go away when you stop taking the drug. Overall, the medication is very well tolerated and is a viable option for travelers looking to take precautions in preventing AMS. This medicine should be started 24 hours before making an ascent, while at altitude and for 48 hours after a descent. PLEASE CONSULT YOUR DOCTOR BEFORE TAKING THE MEDICINE, specially if you are allergic to something.

Dexamethasone 

Dexamethasone is a steroid that can be used as a prophylactic medicine for those unable to tolerate acetazolamide. 

Overall, many travelers go to altitude each day and return without problems. Keep an eye out for symptoms of altitude sickness in yourself and others around you. When travelling in the mountains, follow the golden rules of treating any headache or illness at altitude.

Acute Mountain Sickness in Leh – Ladakh

Going on a Leh trip is on the bucket list of most Indian travellers. In recent years, thousands of indian and foreign nationals are visiting here to enjoy the beauty and serenity of Ladakh.

Attitude sickness among travellers visiting Leh Ladakh is very common. It is very important to manage the symptoms as severe altitude sickness can be very dangerous and in extremely rare conditions, even fatal.

Highest Altitude areas in Leh, Ladakh

Khardung La Pass (17,580 ft)

Tanglang La (17,480 ft)

Changthang (14,846 ft)

Tso Moriri (14,836 ft)

Pangong Tso (14,270 ft)

Acute Mountain Sickness Symptoms in Leh

If you take road journey, you are least likely to suffer from AMS when you reach at Leh. By road, you already would have spent time at higher altitudes than Leh so by the time you get here; your body would already have acclimatized. If you came here by flight; it is strongly recommended  to spend atleast 1 to 2 days in Leh to let your body adjust and then travel to Nubra Valley or anywhere else.

Acute Mountain Sickness Symptoms in Nubra Valley

Nubra Valley is actually at an even lower altitude than Leh city so very low chances of AMS here.

Acute Mountain Sickness Symptoms at Pangong Tso or Tso Moriri

Both these lakes are at a high altitude and chances are that you will suffer some symptoms of AMS here if you are visiting Ladakh first time. So follow the guidelines to get acclimatised properly, keep yourself free from AMS and enjoy the beauty of these places.

Taking the Best Route to Minimize Acute Mountain Sickness Symptoms

The level of altitude mountain sickness may vary along different routes to Leh. You need to plan your journey in a way that the altitude gain happens gradually. You really got to give your body ample time to acclimatize. Taking a specific route can affect your health significantly.

Acute Mountain Sickness Symptoms on Srinagar Leh Highway

This is the best way to minimize the chances of avoiding AMS as You slowly get to high altitude as you travel across the highway and your body adapts better and  your body gets plenty of time to adjust to lower levels of oxygen. You can even stay the night at Kargil if you are concerned about the safety in Leh.  

 Acute Mountain Sickness Symptoms on Manali Leh Highway

This is probably not the best choice if you want to prevent AMS in Leh as altitude increases all of a sudden. The Manali Leh Highway will take you through very high-altitude places like Sachu. Tanglang La, Bharatpur, Pang etc. If you do insist on travelling via this route make sure you make a stop at Darcha, Keylong or Jispa on the first night and from there head to Leh the next morning.

Do not spend a night at the high-altitude places like Bharatpur (Baralacha La),Pangong Tso, Tso Kar and Tso Moriri

Tip: If you wish to do the complete Srinagar- Leh- Manali Circuit, start from Srinagar and end at Manali.

AMS while Flying to Leh

The next best travel route to avoid altitude sickness in Leh is to reach Leh via a flight. This way, once you land in Leh and are hit by AMS, the symptoms would feel more like a bad hangover. Just make sure that as soon as you reach Leh town, give yourself adequate time (24-48 hrs) to acclimatize. During this time make sure you get proper rest and do not exert yourself.Try to reach your accommodation in Leh town as soon as possible.

You can also choose to stay the first night at a lower altitude than Leh like Alchi or Ule Tolpo.

Dealing with Altitude Sickness in Leh Once you Begin to Show Symptoms

Step 1: Stop  ascending

Stop climbing any higher immediately if you start to feel the symptoms of altitude sickness.

Step 2: Rest properly

Once AMS hits you, give your body sufficient time to adapt and for the symptoms to diminish.

Step 3: Descend Immediately

If symptoms don’t get better descend to a lower altitude

Step 4: Visit a Doctor

If the symptoms persist or get any worse, visit a doctor immediately. You can visit the Leh Memorial Hospital or Sonam Norboo Memorial Hospital in Leh Town. the golden rules

  1. If you feel unwell, you have altitude sickness until proven otherwise
  2. Do not ascend further if you have symptoms of altitude sickness
  3. If you are getting worse then descend immediately
HAPO (High-Altitude Pulmonary Oedema)

HAPE/HAPO - High Altitude Pulmonary edema is a condition caused by dangerous excessive fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, thus making it difficult to breathe. In this way, HAPE/HAPO can be fatal within hours.

Normally when we take a breath in, air rushes into the tiny air pockets at the end of all the airway branches in our lungs. At the same time, blood from our heart is brought close to these thin-walled air pockets, so that oxygen can move into our blood while waste products move out.

At altitude because the whole lung is starved of oxygen, blood vessels constricting all over the place and not just in small areas. The blood in these vessels is squeezed and the pressure goes up forcing fluid out of blood and into air pockets. 

This is a serious (potentially life threatening) condition and should not be ignored.

Symptoms

 Most will have symptoms of acute mountain sickness. Often, they will have a cough and this may produce white or pink frothy sputum. The breathlessness will progress and soon they will be breathless even at rest. Heart rate may be fast, the lips may turn blue and body temperature may be elevated. It is easy to confuse symptoms of HAPE/HAPO with a chest infection,

  • Symptoms of AMS
  • Chest Pain
  • Cough with blood in sputum
  • Breathlessness

Who gets HAPE/HAPO?

Evidence suggests that people with chest infections or symptoms of the common cold before ascent may be at higher risk.

Treatment for HAPE/HAPO

Treatment generally includes supplemental oxygen and medication.

Some drugs can be helpful, but should only be used by trained doctors. Nifedipine is a drug that helps to open up the blood vessels in the lungs. By doing so, it reduces the high pressure in those vessels that is forcing fluid out into the lungs. Drug treatment should only ever be used as a temporary measure; the best treatment is descent. If really unable to descend - Portable Hyperbaric Chambers

 bag may be needed.

What to do:

  • • Stay with the person at all times - do not leave them on their own.
  • • Descend now - not later or in the morning.
  • • Sit upright and keep warm.
  • • Give oxygen via cylinder or pressure bag if you have it.

In serious cases death can occur within as little as an hour of symptoms being noticed.

So DESCEND FAST!

Preventing HAPO

If you travel or climb at high altitudes, acclimate yourself slowly. Although recommendations vary, most experts advise ascending no more than 1,000 to 1,200 feet a day once you reach 8,200 feet.

 

HACE (High-Altitude Cerebral Edema)

HACE is a medical condition in which the brain swells with fluid because of the physiological effects of traveling to a high altitude. It occurs when the body fails to acclimatize while ascending to a high altitude. HACE can also occur in people with HAPE and vice versa. Factors that increase the risk of HACE are similar to those for acute mountain sickness and HAPE. 

The main symptoms of HACE:

  • Severe headache.
  • Become clumsy.
  • Act differently - unhelpful, violent, lazy.
  • May have bad, non-stop vomiting.
  • Blurred vision.
  • See, hear, feel, smell odd things.
  • Confused.
  • Reduced consciousness.

Can they:

  • Touch nose with index finger with eyes closed? Repeat rapidly.
  • Walk heel to toe in a straight line?
  • Stand upright, with eyes shut and arms folded?

• Do simple mental maths?

If not able to do or have difficulty doing any of the above, suspect HACE.

HACE can develop very quickly with no other problems or can follow AMS and HAPE.

Treatment of HACE

Descent is the most effective treatment of HACE and should not be delayed if HACE is suspected. A portable altitude chamber, can be used as a temporary measure and, if available, oxygen and a drug called dexamethasone should be given.

In serious cases death can occur within as little as an hour of symptoms being noticed.

So DESCEND FAST!