Mountain Sickness – What Every Traveller Needs to Know

Altitude sickness can really slow down your trip, and also be a potential killer. Our roving medical expert shows you what signs you need to watch out for, and how to prepare for your trip.

Hiking and Avoid Altitude Sickness

Getting high when you travel can be quite adventurous. In fact, it may be the main reason why you head to a destination. Travellers should not be afraid of taking things to the next level, but must also remember a few key points on their trip. Altitude sickness can be deadly, and a little pre-travel preparation can help keep you safe.

Altitude sickness, also called Acute Mountain Sickness (AMS) can really slow down your trip and also be a potential killer. A bit of knowledge and prior to leaving can mean the difference between a very pleasurable and adventurous trip and a headache filled excursion that could potentially end with a medical evacuation from the mountain.

Perhaps the most important tip is to follow the "golden rule of mountain travel": Illness and headache at altitude should be considered altitude sickness until proven otherwise. Basically, if someone is sick at altitude, treat them for altitude sickness first!

Everest Altitude Sickness

WorldNomads.com's roving medical expert Dr. Erik McLaughlin MD discusses altitude sickness and the precautions to take so that high times don't ruin your trip.

How High is High?

To get a better idea of Altitude Sickness, a traveller should understand "How high is high?". Altitude is generally divided into the following levels:

  • High altitude ranges from 1500 to 3000 meters (4950 to 11,500 feet). A traveller headed to the 1500-3000 meter level will typically experience decreased exercise performance and increased breathing rates. Altitude sickness is more common above 2500 meters (8200 feet).
  • Very high altitude ranges from 3500 to 5500 meters (11,500 to 18,050 feet). Severe altitude sickness is more common at this altitude, as well as hypoxia.
  • Extreme altitude is above 5500 meters (18,050 feet). Acclimatization to this altitude is impossible and rapid ascent to this altitude is very dangerous.

Travellers headed to high altitude need to also be aware of a few medical terms and conditions that they might encounter themselves or in their traveling companions.

Acute Mountain Sickness/AMS

This is the broad term for altitude sickness. Symptoms of AMS include headache (often throbbing, worse when bending over), nausea/vomiting, fatigue and a general feeling of a "hangover".

High Altitude Cerebral Edema (HACE)

Is a life threatening emergency that has symptoms of ataxia (walking in a stumbling manner) and changes in mental status such as confusion or lethargy. This is literally swelling of the brain. Symptoms of AMS are also usually present. This is a medical emergency!

High Altitude Pulmonary Edema (HAPE)

Is a life threatening emergency with symptoms of cough (wet or dry), difficulty breathing with mild exertion and all the symptoms of AMS. Fluid collects in the patient's lungs. This is a medical emergency!

Treatment of AMS, HCE and HAPE

The definitive treatment for all mountain sickness is descent.

Treatment of high altitude sickness of all kinds centers around prompt recognition of the symptoms and thinking that altitude could be the cause of the illness. First and foremost, upon beginning to feel ill when at altitude, a person should not ascend any higher!

Some experts even advise descending 500-1000 meters for 24 hours to allow the body to acclimatize more slowly. Medical treatment of more severe forms of altitude sickness such as HACE and HAPE should be done by a person skilled in altitude medicine. A traveller who suspects HACE or HAPE should immediately descend to lower altitude and seek advanced medical care. Some medications discussed below may aid in the treatment, but descent is the best medicine.

Portable hyperbaric chambers known as Gamow bags can be used to simulate a lower altitude environment in emergencies and should be used only while preparing to evacuate the patient to a lower level, not as a substitute to descent.

Prevention of Acute Altitude Sickness

Travelers looking to prevent altitude sickness should try to have a slow and gradual ascent to altitude. Some experts advise not climbing more than 1500-2000 meters in a 24 hour period, when traveling above 2500 meters. This gives the body a chance to acclimatize to the new altitude and an opportunity to observe people for symptoms of AMS. This slow and gradual ascent is easier when travellers are hiking. Modern day travel methods such as car travel and airlines that land in cities such as Lhasa, Tibet and Cusco, Peru can immediately put a traveller at high altitude without much time to acclimatize. A savvy traveller will be already on the look-out for AMS symptoms if traveling to high-attitude without much of a chance to acclimatize.

Given that a slow and gradual ascent is not always possible, a few methods can help adjust the body to the shock of suddenly being at high altitude. Some evidence supports mild exercise the day of arrival such as a short walk, to aid with acclimatization. Heavy exercise the day of arrival could be disastrous.

Avoidance of alcohol or sedatives which can mask the symptoms of AMS should be for the first few days of altitude, as well. Adequate hydration should also be stressed.

Medicine to Prevent or Treat Acute Altitude Sickness

Certain medications can help prevent and even treat AMS. Perhaps the most commonly used medication is called acetazolamide. This medication is used to both prevent and treat symptoms of AMS. Often taken as a 125mg tablet, twice per day, Acetazolamide is very effective at preventing AMS symptoms. This medication has the potential to cause allergic reactions in those people with a history of sulfa allergies and can change the way some foods or drinks taste, especially carbonated beverages. Overall, the medication is very well tolerated and is a viable option for travellers looking to take precautions in preventing AMS. This medicine should be started 24 hours before one ascends and taken while at altitude and for 48 hours after descent.

Dexamethasone is a steroid that can be used as a prophylactic medicine for those people unable to tolerate acetazolamide. This medicine is best used as treatment but is still an option.

Ginko Biloba has received much attention as a possible prophylactic AMS drug but the medical literature is scant. Some research shows promise but acetazolamide is still considered superior.

Lastly, the use of Cocoa leaves or other products that contain this plant material should be discouraged by travellers. While having many other applications, decent prevention of AMS symptoms is not one of them. Perhaps most dangerous is the "false sense of security" that one might have by taking cocoa leaf products and ignoring symptoms of AMS believing they are protected.

Overall, many travellers go to altitude each day and return without problems. Keeping an eye out for symptoms of altitude sickness in yourself and others around you should be second nature. When traveling in the mountains, follow the golden rule of treating any headache or illness at altitude as altitude sickness until proven otherwise. Discuss your travel plans and more importantly your ascent rate with your travel doctor in advance and see if using any prophylactic medications might be right for your trip.

6 Comments

  • Chris said Reply

    Also had many many local Sherpas in Nepal swear by Garlic soup

  • Maryanne Haslam said Reply

    I made it to Everest Base camp out of Llasa as an elderly unfit traveller by taking prescription medication AS DIRECTED, ie before ascending. Several travel companions, fitter and younger, suffered badly having waited until symotoms set in.

    • Molly Sweat said Reply

      I'll be traveling from china to Lhasa, I'm 52 years old. I've been hiking for about 3 weeks. After reading more about Lhasa I should have started a few weeks earlier. Can you tell me what prescription medication you took? Thank you

    • Chris said Reply

      Maryanne, that is very encouraging. Hubby and I have been thinking about a trip to Base Camp in 2 years time. Hubby is 66 and I am 65 and all of our family and friends think we have lost our minds.

  • Karen said Reply

    I travelled to Jiuzhaigou, China, in October 2016. 59 years old. Solo traveller. Took all the precautions, started the prescribed medication as directed, always had water with me, ensured I was comfortable - all this before I even stepped off the bus. At about 800m I started to feel the effects of AMS. It is very difficult to turn around, particularly when in a bus, when travelling up a sparsely populated area. I did make it to my destination, the medicine helped somewhat, but the decision to leave the day after I had gone to the park (maximum altitude 3000m) seemed the best plan. My main suggestion is to seriously consider having a travel partner for such excursions. I was fortunate to meet a kind young man who stayed with me at the park, ostensibly to practice his English, but perhaps also because he saw I was alone and reminded him of his parents.

  • Anne W said Reply

    I was 63, overweight and medium fit when I flew from Nepal into an airport near Lhasa. I had meds for AMS with me but had not started taking the tablets. There was a delay with our flight so our tour guide changed our itinerary. We were taken to a high monastery on route to Lhasa.This was quite a climb which meant we were forced into quite heavy exertion without a chance to acclimatise. Next day I felt ill and so did several others in their 20's and 30's all fitter and thinner than me. I had to back out of the morning activities and the meds I had gave me the runs. We visited several high monasteries up endless steps on route to base camp and I was slow in climbing the steps. I lost my appetite but managed some soup and ginger, lemon and honey in hot water.... always on offer. I acclimatised in a few days but never really recovered until our descent when a sudden feeling of wellness and energy came over me. All I can say is go to these wonderful places but be aware.

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