Tips on AMS (Acute Mountain Sickness)
You can probably find a lot of varying literature on AMS prevention and treatment anywhere on the internet. When we were preparing for the trip, we read up all we could but, honestly, it was all very confusing. Some guide services recommended Diamox. Other experts didn't. We tried asking some local doctors, but they were not experts on the matter either. Besides Diamox was really hard to get locally.
When we got to Machermo 4400m, almost everyone in our group (all eight of us)already had AMS to some degree. I started on Diamox, which we found in abundance in Kathmandu, at 125mg early on at Namche Bazaar (3450m) because I knew from previous experience that I had reactions to altitude after 1,500m. I had to bump up my dosage to 250mg when we did a 'rest day' hike that took us up to 3,800m and back down again to 3,450m. That evening 4-5 of my trekking mates we already suffering mild to intermediate symptoms of AMS. The symptoms varied from 'blue' lips to headaches to vomiting and 'wild sleepless nights'.
I continued my course of Diamox for the rest of the hike. Taking 125mg - 250mg each evening, depending on the expected altitude gain the next day. If we were climbing no more than 400m altitude gain, I took only 125mg of Diamox before bed. I was free of AMS for the rest of the trip but when we got to Machermo, five of my trekking mates had to visit the Rescue Post Clinic for medication; some for AMS, others for severe diarrhea.
We took the opportunity to sit in the infamous 3 o'clock AMS lecture and asked as many questions as we could (I found out that my severe backache the previous day was due to my kidneys reacting to the Diamox and that I was not hydrating enough despite my drinking more than normal).
We found the AMS lecture so informative that we took digital pictures of the lecture notes. Hopefully, it might help you in planning your next high altitude trip.
This is a copy of the notes.
RISK FACTORS and PREVENTION
- Individual susceptibility
- Going up too fast - suggest sleep no higher than 400m above previous night once above 2,500m - 3,000m. Have a rest day every 3 days or every 1,000m (can do acclimatization hike "climb high, sleep low")
- Over exertion
- Fluid intake - should have 3-4 liters a day
- Avoid Alcohol, caffeine, sedatives!! (or limit)
- Avoid getting cold
- Eat regularly
- Can take Diamox preventatively
SLEEP AT ALTITUDE
Can be a big problem!
- Difficult to get off to sleep
- Poor quality shallow sleep
- Periodic breathing - oxygen levels go very low when stop breathing
- Can take Diamox early evening
- 125mg initially, up to 250mg if necessary
COUGH AT ALTITUTE
Can be a big problem!
- May be: infection or HAPE
- May just be dry air
TREATMENT OF AMS
- Rest (don't go higher with symptoms)
- Drink, eat, keep warm
- mild painkiller eg. ibuprofen or paracetamol
- anti-nausea medicine eg. metoclopramide
MODERATE OF SEVERE:
- DESCEND, DESCEND, DESCEND!
- never alone
- may need to be carried (porters, horse, yak)
- 500m or more
- Oxygen if available
- Acetazolamide (Diamox) 250mg twice a day
- Dexamethasone if severe
- PAC or Gamow bag (but don't delay descent)
Can be used to prevent AMS as well as treatment
Only recommended for people who get AMS easily or if you have to go up very fast (eg. a rescue)
Start night before ascent above 3,000m
Continue until maximum height reached and starting to descend
Dose (for prevention) 125mg - 250mg twice a day
- tingling /numbness
- fizzy drinks and beer taste flat :-(
- pee more
- try it first
Don't take DIAMOX if you have sulphur allergy
Diamox doesn't mask symptoms of AMS
It works on your kidneys to stimulate you to breathe more
HIGH ALTITUDE PULMONARY OEDEMA (H.A.P.E.)
- Fluid in the lungs and high pressure in lung blood vessels due to low oxygen
- Can come suddenly or slowly
- Can get HACE too as so low on oxygen
- More breathless than others
- Breathless at rest
- Can't lie flat
- Very tired
- Descend (must be helped or carried)
- Oxygen and/or PAC bag
- Salbutamol inhaler
- Nifedipine, Viagra, Diamox
HIGH ALTITUDE CEREBRAL OEDEMA (H.A.C.E)
- Like severe AMS - vomiting and bad headache + CONFUSION and/or CLUMSINESS (ataxia)
- may become unconscious
Fluid on the brain
- DESCEND - carry or help patient - AT ONCE!
- Oxygen, PAC
- Dexamethasone 8mg and then 4mg every 6 hours
- Should be flown out + medical follow up
< Search for more information on AMS online before climb anything more than 3,000m. Your homework will help you get higher. Have a successful journey>