What are the risks of altitude sickness for mountain climbers. How can altitude sickness be prevented and treated. What are the symptoms of severe altitude sickness. How does ascending too rapidly affect the body at high altitudes.

Understanding Altitude Sickness: A Threat to Mountain Climbers

Altitude sickness, also known as mountain sickness, poses a significant risk to mountain climbers and high-altitude travelers. This condition occurs when individuals ascend too quickly to high elevations, not allowing their bodies sufficient time to adjust to the reduced oxygen levels and changes in air pressure. The result is hypobaric hypoxia, a state where the body’s tissues don’t receive enough oxygen.

At intermediate altitudes (1,500 to 2,500 meters above sea level), the likelihood of developing altitude sickness is relatively low but still possible. However, acute altitude sickness can manifest after spending just four hours at elevations exceeding 2,000 meters. Climbing to heights above 2,500 meters significantly increases the risk of experiencing various symptoms, including headaches and vomiting.

Recognizing the Symptoms of Altitude Sickness

Identifying the early signs of altitude sickness is crucial for preventing its progression to more severe forms. The initial symptoms typically include:

• Headache
• Lethargy
• Decreased performance
• Lack of coordination
• Insomnia
• Loss of appetite
• Dizziness
• Nausea
• Vomiting

Is there a difference in susceptibility between men and women? Research suggests that men are at a higher risk of developing altitude sickness compared to women, although the exact reasons for this disparity remain unknown. It’s important to note that being young and fit does not necessarily reduce one’s risk, and previous experiences with altitude sickness do not guarantee immunity in future climbs.

Severe Altitude Sickness: Understanding the Risks

When altitude sickness progresses to its severe form, it can manifest as two main conditions: high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE). In many cases, both conditions occur simultaneously, posing a significant threat to the climber’s life.

High Altitude Pulmonary Edema (HAPE)

HAPE is characterized by the accumulation of fluid in the lungs. The symptoms of HAPE include:

• Breathlessness
• Heart palpitations
• Blue-tinged skin and nails (cyanosis) due to oxygen deprivation
• Frequent coughing with frothy or blood-tinged sputum

Can HAPE be life-threatening? Yes, in severe cases, individuals with pulmonary edema may drown if their lungs fill with excessive fluid.

High Altitude Cerebral Edema (HACE)

HACE involves the accumulation of fluid in the brain. Symptoms of HACE may include:

• Irrational behavior, such as denying symptoms
• Inability to sit up or walk in a straight line
• Severe headache
• Confusion and disorientation

Preventing Altitude Sickness: Key Strategies for Climbers

The most effective way to prevent altitude sickness is to ascend slowly, allowing your body time to acclimatize. Here are some essential guidelines for a safe ascent:

1. Above 3,000 meters, limit your daily ascent to 300 meters or less.
2. Take an extra day of rest and acclimatization for every 1,000 meters gained beyond 3,000 meters.
3. Consult your doctor before your trip for advice and potential preventive medications.
4. Consider switching to a high-carbohydrate diet before trekking, as some climbers believe this may help reduce risks.
5. Pack necessary first aid items and medications, including acetazolamide, which has shown effectiveness in prevention.
6. Climb only with experienced guides who can recognize and respond to altitude sickness symptoms.
7. Increase your fluid intake to up to seven liters per day.
8. Avoid cigarettes, alcohol, and sleeping tablets, as these can exacerbate hypoxia.

Are there any medications that can help prevent altitude sickness? Acetazolamide has shown considerable effectiveness as a preventative measure, especially for those flying directly to high-altitude locations. Some climbers also use salmeterol inhalers and even Viagra-like drugs to prevent fluid buildup in the lungs. However, it’s crucial to note that medications like nifedipine and dexamethasone are best used for treating mild altitude sickness rather than prevention, as they may mask early warning signs.

First Aid for Altitude Sickness: Immediate Actions

When a member of your climbing party shows signs of altitude sickness, prompt action is crucial. Here are the essential first aid steps to take:

1. Halt the ascent immediately and set up camp.
2. Wait for symptoms to subside, which may take a couple of days.
3. Ensure the affected individual avoids alcohol and cigarettes.
4. Administer aspirin or paracetamol in recommended doses for symptom relief.
5. Encourage deep breathing every few minutes to decrease blood carbon dioxide levels.
6. If necessary, administer recommended doses of dexamethasone.

When should you consider descending? In severe cases of altitude sickness, immediate descent is crucial. Aim for a descent of 500 to 1,000 meters to alleviate symptoms and reduce risk.

The Importance of the ‘Buddy System’ in High-Altitude Climbing

Implementing a ‘buddy system’ is vital when climbing at high altitudes. This approach is necessary because individuals suffering from altitude sickness often refuse to acknowledge their own symptoms. It’s not uncommon for affected climbers to stubbornly resist descending, even when it’s in their best interest.

How does the buddy system work in practice? Climbers should pair up and regularly check on each other’s condition. This includes monitoring for symptoms, assessing cognitive function, and making joint decisions about continuing the ascent or descending if necessary. By relying on a partner’s objective assessment, climbers can overcome the potential denial of symptoms that often accompanies altitude sickness.

Advanced Treatment Options for Severe Altitude Sickness

In cases of severe altitude sickness, particularly when immediate descent is not possible, more advanced treatment options may be necessary. These can include:

• Oxygen therapy: Administering supplemental oxygen from portable containers can quickly alleviate symptoms and buy time for descent or evacuation.
• Hyperbaric chambers: Portable hyperbaric chambers can simulate lower altitudes, providing temporary relief and stabilization.
• Medications: In addition to dexamethasone, other drugs like nifedipine may be used under medical supervision to manage severe symptoms.

When should advanced treatments be considered? Advanced treatments should be implemented when symptoms are severe, descent is impossible or delayed, or when the climber’s condition is deteriorating rapidly despite initial first aid measures.

Long-Term Effects and Recovery from Altitude Sickness

While most cases of altitude sickness resolve without long-term consequences once the individual descends to lower elevations, severe cases can have lasting effects. These may include:

• Persistent fatigue and weakness
• Cognitive impairments
• Respiratory issues
• Increased susceptibility to future episodes of altitude sickness

How long does it take to fully recover from severe altitude sickness? Recovery time varies depending on the severity of the case and the individual’s overall health. Mild cases may resolve within a few days of descent, while severe cases can take weeks or even months for full recovery. In some instances, individuals may experience subtle neurological or physiological changes that persist for extended periods.

To promote recovery, it’s essential to:

1. Allow ample time for rest and recuperation at lower altitudes
2. Stay well-hydrated and maintain a nutritious diet
3. Gradually reintroduce physical activity under medical supervision
4. Attend follow-up medical appointments to monitor for any lingering effects
5. Consider psychological support, as severe cases can be traumatic experiences

Technological Advancements in Altitude Sickness Prevention and Management

As mountain climbing and high-altitude tourism continue to grow in popularity, technological innovations are emerging to help climbers better prevent and manage altitude sickness. Some of these advancements include:

• Wearable devices that monitor oxygen saturation and heart rate in real-time
• Mobile apps that track ascent rates and provide personalized acclimatization recommendations
• Improved portable oxygen systems with longer-lasting and lighter-weight designs
• Enhanced communication devices for emergency situations in remote areas

How are these technologies changing high-altitude climbing? These innovations are making it easier for climbers to monitor their physiological responses to altitude, make informed decisions about ascent rates, and respond more quickly to emerging symptoms of altitude sickness. However, it’s important to note that while technology can be a valuable tool, it should not replace proper training, experience, and adherence to safe climbing practices.

Ethical Considerations in High-Altitude Climbing and Altitude Sickness

The pursuit of high-altitude summits raises several ethical questions, particularly concerning the risks of altitude sickness and the responsibilities of climbers and expedition organizers. Key considerations include:

1. The balance between personal achievement and safety
2. The role of commercial expeditions in potentially encouraging unsafe practices
3. The environmental impact of increased traffic on high-altitude mountains
4. The strain on local resources and rescue services in remote areas

What responsibilities do climbers and expedition organizers have regarding altitude sickness? Climbers have a personal responsibility to educate themselves about the risks, prepare adequately, and make responsible decisions during their ascent. Expedition organizers, on the other hand, have a duty of care to their clients, which includes providing accurate information, ensuring proper acclimatization protocols, and having contingency plans for medical emergencies.

The mountaineering community continues to debate these issues, striving to find a balance between preserving the challenge and adventure of high-altitude climbing while minimizing unnecessary risks and environmental impact.

Future Research Directions in Altitude Sickness

As our understanding of altitude sickness evolves, several areas of research show promise for improving prevention and treatment strategies:

• Genetic factors: Investigating why some individuals are more susceptible to altitude sickness than others
• Biomarkers: Identifying reliable indicators that can predict the onset of altitude sickness before symptoms appear
• Novel medications: Developing drugs that can more effectively prevent or treat altitude sickness with fewer side effects
• Acclimatization protocols: Refining strategies for optimal pre-acclimatization and staged ascent
• Long-term effects: Studying the potential cumulative impacts of repeated high-altitude exposure

How might future research change our approach to high-altitude climbing? Advances in these areas could lead to more personalized risk assessments, targeted prevention strategies, and improved treatment options for altitude sickness. This could potentially make high-altitude climbing safer and more accessible while still preserving the challenge that draws many to the world’s highest peaks.

As research progresses, it’s crucial for the mountaineering community to stay informed about new findings and incorporate evidence-based practices into their climbing strategies. This ongoing dialogue between scientists, medical professionals, and climbers will be key to advancing our understanding and management of altitude sickness in the years to come.

Altitude sickness – Better Health Channel

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Summary

Read the full fact sheet

• Mountain climbers are at risk of developing altitude sickness.
• Altitude sickness is caused by ascending too rapidly, which doesn’t allow the body enough time to adjust to reduced oxygen and changes in air pressure.
• Symptoms include headache, vomiting, insomnia and reduced performance and coordination.
• In severe cases, fluid can build up within the lungs, brain or both, which can be fatal.
• First aid options include descending immediately, medications and the use of oxygen administered from a portable container.

Mountain climbers are at risk of developing altitude sickness (also known as mountain sickness), which may be harmful or even fatal if its onset is ignored. It is caused by gaining altitude too rapidly, which doesn’t allow the body enough time to adjust to reduced oxygen and changes in air pressure, and causes hypobaric hypoxia (a lack of oxygen reaching the tissues of the body).

In severe cases, fluid builds up within the lungs, brain or both. At intermediate altitude (1,500 to 2,500 metres above sea level) altitude illness is unlikely, though possible. Acute altitude sickness arises after at least four hours spent at an altitude above 2,000 m. Ascending to heights greater than 2,500 m can trigger a range of symptoms including headache and vomiting.

Men are at greater risk of altitude sickness than women, for reasons unknown. It is important to remember that being young and fit doesn’t reduce your risk, and just because you haven’t experienced altitude sickness in the past, doesn’t mean you are immune to the condition during future climbs. The only sure method of prevention is to take plenty of time to ascend.

Symptoms of altitude sickness

The initial symptoms of altitude sickness can include:

• Headache
• Lethargy
• A drop in performance
• Lack of coordination
• Insomnia
• Appetite loss
• Dizziness
• Nausea
• Vomiting.

Severe altitude sickness

There are two main types of severe altitude sickness: high altitude pulmonary oedema (fluid within the lungs) and high altitude cerebral oedema (fluid within the brain). In most cases, both conditions occur at the same time. A person with pulmonary oedema may drown if their lungs fill with too much fluid.

Symptoms of severe altitude sickness include:

• Breathlessness
• Heart palpitations
• Blue-tinged skin and nails due to lack of oxygen (cyanosis)
• Frequent coughing because of fluid in the lungs
• Sputum may be frothy or tinged pink with blood from the damaged lung tissue
• Irrational behaviour, such as refusing to acknowledge symptoms
• Inability to sit up or walk in a straight line.

Prevention of altitude sickness

The best way to prevent altitude sickness is to ascend slowly. Once you are more than 3,000 m above sea level, only advance 300 m or less per day. Be sure to take an extra day of rest and acclimatisation for every subsequent 1,000 m.

Other suggestions for preventing altitude sickness include:

• See your doctor for information and advice before your trip.
• Some climbers believe that switching to a high-carbohydrate diet before they go trekking helps to reduce the risks.
• Be prepared. Pack all necessary first aid items, including medications.
• Considerable evidence exists for the effectiveness of acetazolamide as a preventative. It is particularly useful if you are flying into a location at altitude and will not have time to adjust. Salmeterol inhalers and even Viagra-like drugs have been used to prevent fluid building up in the lungs.
• Remember that medications such as nifedipine and dexamethasone are best used as a treatment for mild altitude sickness, not as a prevention measure. These medications could mask the early warning signs.
• Only climb with experienced guides.
• Increase your fluid intake. You may need up to seven litres every day.
• Avoid cigarettes and alcohol.
• Sleeping tablets must not be used, as they can lead to an increase in hypoxia due to their central nervous system depressing action.
• Be aware that you are at increased risk of altitude sickness if you have experienced it before.

First aid for altitude sickness

Use the ‘buddy system’, because you will most likely refuse to acknowledge your own symptoms of altitude sickness. It is not unusual for affected climbers to stubbornly refuse to descend.

If one of your party is showing the signs of altitude sickness, first aid suggestions include:

• Don’t climb any higher. Camp and wait until the symptoms subside. This can take a couple of days.
• Make sure they avoid alcohol and cigarettes.
• Give them aspirin or paracetamol in the usual recommended doses.
• Encourage them to breathe deeply every few minutes to decrease the level of carbon dioxide in their blood.
• Give them the recommended doses of the drug dexamethasone.
• In severe cases of altitude sickness, descend immediately. Aim for a descent of around 500 m to 1,000 m.
• Give them diuretic drugs (which promote urine production) to reduce the risk of fluid accumulation.
• Administer oxygen from a portable oxygen cylinder.

Treating altitude sickness with hyperbaric oxygen therapy

Hyperbaric oxygen therapy uses specially designed chambers or rooms that can withstand high pressures. Air at sea level contains 21 per cent oxygen, while hyperbaric oxygen therapy can deliver up to 100 per cent pure oxygen.

This form of therapy floods the body with oxygen and relieves the symptoms of altitude sickness. A portable oxygen cylinder enables oxygen to be administered via a facemask or hood.

Never use oxygen therapy or altitude sickness medications to continue an ascent once symptoms have occurred. The result can be fatal.

Where to get help

• Your doctor

Things to remember

• Mountain climbers are at risk of developing altitude sickness.
• Altitude sickness is caused by ascending too rapidly, which doesn’t allow the body enough time to adjust to reduced oxygen and changes in air pressure.
• Symptoms include headache, vomiting, insomnia and reduced performance and coordination.
• In severe cases, fluid can build up within the lungs, brain or both, which can be fatal.
• First aid options include descending immediately, medications and the use of oxygen administered from a portable container.

• What is hyperbaric oxygen therapy? Hyperbaric Medicine Unit, Royal Adelaide Hospital, South Australia.
• Dawka S, Barthakur R, 2008, ‘Altitude sickness: a review’, Journal of Gandaki Medical College, vol 1, no. 1.
• Schommer K, Bärtsch P, 2011, ‘Basic medical advice for travellers to high altitudes’, Deutsches Ärzteblatt International vol. 108, no. 49, pp. 839–848. More information hereExternal Link.
• Altitude illness, Centers for Disease Control and Prevention, USA. More information hereExternal Link.

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Reviewed on: 21-08-2014

Is there such thing as reverse altitude sickness?

Brad Mitchell/Alamy

When creatures accustomed to life at high altitude are brought to sea level, do they experience reverse altitude sickness?

David Muir, Edinburgh, UK

Humans can certainly experience reverse altitude sickness, known as high-altitude de-acclimatisation syndrome (HADAS).

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When people who live at low altitude have adjusted to a high-altitude, low-oxygen environment, they can get any of a large number of possible symptoms of HADAS when returning to a lower altitude. Climbers and athletes have documented these physiological effects. HADAS is particularly significant in China, where millions of temporary workers migrate from their homes at low altitude to the high plateaus of Qinghai and Xinjiang.

At the end of their spell of employment, many experience HADAS after descending back to their homes. Scientists in China have shown that high-altitude de-acclimatisation induces oxidative stress, resulting in cell and tissue damage.

Members of populations that have evolved to live at high altitude, such as Tibetans, have also experienced HADAS on moving to sea level.

Because humans who have naturally adapted to live at high altitude may experience HADAS, as well as those who have become temporarily acclimatised, the same is likely to be the case for other mammals. Whether this is true for all vertebrate groups could be a bone of contention.

Chris Daniel, Colwyn Bay, Conwy, UK

Adaptation to altitude has been found to be different in two populations, Tibetans and the Andean peoples.

Tibetans have a level of oxygen-carrying haemoglobin in their blood that is similar to that of lowlanders, but they breathe faster and produce more nitric oxide that promotes vasodilation, or widening of the blood vessels, to carry blood more efficiently around the body.

Andeans, on the other hand, have more haemoglobin and larger lungs, so they can absorb more of the available oxygen from each breath.

One study has found that Tibetans who are genetically adapted to high altitudes but born at lower ones don’t seem to differ from lowlanders in their metabolic response to exercise, although their breathing rate is greater. Another has found that the Quechua Andean people have higher oxygen saturation in their blood than lowlanders regardless of whether they were born at high or low altitude.

Athletes have used the temporary effect of high-altitude adaptation to improve their performance. The most popular method is “live high, train low”, in which athletes sleep at locations up to 2500 metres above sea level, where the lower air density means there is a reduced amount of oxygen.

“Altitude rooms” are another option. These can be used to control oxygen levels to simulate elevated altitudes even up to the height of Everest. Such conditions stimulate the hormone erythropoietin to produce more haemoglobin to restore oxygen to normal levels in the body.

Athletic training, however, takes place at lower altitudes, where the additional oxygen-carrying capacity of the blood enables higher rates of exercise to take place.

This suggests that it isn’t inherently dangerous to adapt to a high altitude and then descend quickly to a low level, as the body will make use of the greater oxygen-carrying capacity of the blood to do more physical activity or lower the breathing rate to reduce the intake of oxygen.

Ruth Garodd, London, UK

Maybe reverse altitude sickness of a sort does exist. When I was trekking in Nepal, I learned that if the Sherpas (born and bred at altitude) play the porters (born and bred in the valleys) at football, then the Sherpas will always win if the match is played at altitude, but the porters will always win in the valleys.

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Altitude sickness is no joke!

June 23

Tips and instructions

high altitude climbing
adventure team

Source: AlpIndustriya Adventure Team

Mountain sickness (mountain climber, akklimukha – slang) is a disease state of the human body that has risen to a considerable height above sea level, which occurs due to hypoxia (insufficient oxygen supply to tissues), hypocapnia (lack of carbon dioxide in tissues) and is manifested by significant changes in all organs and systems of the human body.

With incorrect treatment or incorrect actions (delayed evacuation down), mountain sickness can even lead to the death of the sick person. Sometimes very quickly.

Since a professional physician is not present in every sports group, in this article we will try to make the symptoms of mountain sickness “recognizable”, and the treatment tactics understandable and justified.

Recommendations from AlpIndustriya Tour.

At what altitudes should mountain sickness be expected?

At altitudes of 1500-2500 m above sea level, minor functional changes in well-being are possible in the form of fatigue, increased heart rate, and a slight increase in blood pressure. After 1-2 days (depending on the fitness of the athlete), these changes usually disappear. Blood oxygen saturation at this altitude is practically within the normal range.

Fast ascent 2500-3500 m above sea level, the symptoms of hypoxia develop very quickly and also depend on the training of athletes. When planning very short acclimatization periods for a group, which is far from uncommon now, if after a training ascent on the 3rd-4th day of ascent, a sports group already goes to a technically difficult route, the participants may experience symptoms from the nervous system – inhibition on the route, poor or slow execution of commands, sometimes euphoria develops. A calm and modest athlete suddenly starts arguing, screaming, behaving rudely. In this case, it is very important to immediately check the indicators from the cardiovascular system – hypoxia will be manifested by an increase in heart rate (more than 180), an increase in blood pressure (this can be determined by the strength of the pulse wave at the wrists), an increase in shortness of breath (an increase in the number of breaths by more than 30 for 1 minute). If these symptoms are present, the diagnosis of altitude sickness can be made with certainty.

At an altitude of 3500-5800 meters blood oxygen saturation will be much less than 90% (and 90% is considered the norm), so manifestations of altitude sickness are more common, and the development of its complications is also often observed: cerebral edema, pulmonary edema.

During sleep, the patient may experience abnormal rare breathing (the so-called “periodic” breathing, caused by a decrease in the level of carbon dioxide in the blood), mental disorders, hallucinations. A decrease in carbon dioxide in the body leads to a decrease in the frequency of breaths during sleep due to a decrease in the activity of the respiratory center of the brain (when a person is awake, the number of breaths is regulated by consciousness), which further increases hypoxia. This usually manifests itself in the form of asthma attacks or even temporary pauses in breathing during sleep.

The symptoms of altitude sickness may be exacerbated by intense physical activity. However, a slight physical activity is useful, as it stimulates anaerobic metabolic processes in the body and neutralizes the increase in hypoxia in organs and tissues. The need to move in order to overcome it was mentioned by many high-altitude athletes (Reinhold Messner, Vladimir Shataev, Eduard Myslovsky).

Level above 5800 m belongs to extreme heights above sea level, prolonged stay at such an altitude is dangerous for humans. A high level of ultraviolet radiation, strong, sometimes hurricane winds, temperature changes quickly lead to dehydration and exhaustion of the body. Therefore, those who climb to such a height must be very hardy and trained to the effects of hypoxia, they must consume a sufficient amount of water and high-calorie quickly digestible foods during the ascent.

At an altitude above 6000 m full acclimatization is even more difficult, in this regard, even many trained high-altitude climbers noted numerous signs of mountain sickness during their stay at high altitudes (fatigue, sleep disturbances, slow reaction time, headache, impaired taste sensations, etc.).

At altitudes over 8000 m a non-acclimatized person can stay without oxygen for no more than 1-2 days (and even then in the presence of a general high level of fitness and internal reserves). The term “Zone of death” (lethal zone) is known – a high-altitude zone in which the body spends more energy to ensure its own life than it can receive from external sources (nutrition, respiration, etc.). Extreme confirmation of the lethality of altitude is information from aviation medicine – at altitudes of about 10,000 m, a sudden depressurization of the aircraft cabin leads to death if oxygen is not urgently connected.

How does altitude sickness develop? body – to the brain, kidneys, liver, stomach, as well as to the muscles and ligaments.

As the altitude increases, the amount of oxygen in the surrounding air decreases and its amount in the human blood decreases. This condition is called hypoxia. In the case of slight hypoxia, the body responds to a decrease in the level of oxygen in the tissues, first of all, by an increase in heart rate (increase in heart rate), an increase in blood pressure, and the release of more young erythrocytes from the hematopoietic organs – the depot (liver, spleen, bone marrow). capture additional oxygen, normalizing gas exchange in the lungs.

In mountains, especially high ones, other factors are added to the decrease in the oxygen content in the air: physical fatigue, hypothermia, and dehydration at altitude. And in case of accidents, there are also injuries. And if in such a situation one does not influence the body correctly, the physiological processes will go through a “vicious circle”, complications will join, and the life of the climber may be in danger. At altitude, the rate of pathological processes is very high, for example, the development of pulmonary or cerebral edema can cause the death of the victim in a few hours.

The main difficulty in diagnosing mountain sickness is primarily due to the fact that most of its symptoms, with a few exceptions (for example, intermittent shortness of breath), are also found in other diseases: cough, shortness of breath and shortness of breath in acute pneumonia, pain in stomach and digestive disorders – in case of poisoning, impaired consciousness and orientation – in traumatic brain injuries. But in the case of mountain sickness, all of these symptoms are observed in the victim either when rising quickly to a height, or when staying at a height for a long time (for example, when waiting for bad weather).

Many conquerors of eight-thousanders noted drowsiness, lethargy, poor sleep with symptoms of suffocation, and their well-being immediately improved with a rapid loss of height.
Contribute to the development of mountain sickness and worsen well-being at altitude as well as common colds, dehydration, insomnia, overwork, drinking alcohol or coffee.

Yes, and simply tolerance to high altitudes is very individual: some athletes begin to feel worse at 3000-4000 m, others feel great even at a much higher altitude.

That is, the development of altitude sickness depends on individual resistance to hypoxia, in particular on:

• gender (women tolerate hypoxia better),
• age (the younger the person, the worse he tolerates hypoxia),
• general physical training and mental state,
• climb speed,
• as well as from the past “high-altitude” experience.

The geography of the location also influences (for example, 7000 m in the Himalayas are easier to bear than 5000 m on Elbrus).

So how does an athlete’s body react to a significant reduction in oxygen in the surrounding air?

Increased pulmonary ventilation – breathing becomes more intense and deep. The work of the heart increases – the minute volume of circulating blood increases, blood flow accelerates. Additional red blood cells are released from the blood depots (liver, spleen, bone marrow), as a result, the hemoglobin content in the blood increases. At the tissue level, capillaries begin to work more intensively, the amount of myoglobin in the muscles increases, metabolic processes intensify, new metabolic mechanisms are activated, for example, anaerobic oxidation. If hypoxia continues to grow, pathological disorders begin in the body: insufficient supply of oxygen to the brain and lungs leads to the development of severe complications. A decrease in the level of oxygen in the tissues of the brain first leads to disturbances in behavior, consciousness, and further contributes to the development of cerebral edema. Insufficient gas exchange in the lungs leads to reflex stagnation of blood in the pulmonary circulation and the development of pulmonary edema.

Reduced blood flow in the kidneys leads to a decrease in the excretory function of the kidneys – first a decrease, and then a complete absence of urine. This is a very alarming sign, because a decrease in the excretory function leads to a rapid poisoning of the body. A decrease in oxygen in the blood of the gastrointestinal tract can be manifested by a complete lack of appetite, abdominal pain, nausea, and vomiting. In addition, with a decrease in the level of oxygen in the tissues as a result of a violation of water-salt metabolism, dehydration of the body progresses (fluid loss can reach 7-10 liters per day), arrhythmia begins, and heart failure develops. As a result of impaired liver function, intoxication quickly develops, body temperature rises, and fever in conditions of lack of oxygen increases hypoxia (it has been established that at a temperature of 38 ° C the body’s need for oxygen doubles, and at 39. 5°C increases by 4 times).

Attention! With a high temperature, the patient must be immediately lowered down! To any pathology, “minus” can add a catastrophic “minus”!

Aggravates the state of health and the effect of cold:

• Firstly, in the cold, breathing is usually short, and this also increases hypoxia.
• Secondly, at low temperatures, other colds (tonsillitis, pneumonia) can join pulmonary edema.
• Thirdly, the permeability of cell walls is disturbed in the cold, which leads to additional tissue edema.

Therefore, at low temperatures, pulmonary edema or cerebral edema occurs and develops faster: at high altitudes and in severe frost, this period, up to a fatal outcome, can be only a few hours instead of the usual 8-12 hours.

The rapid onset of death is explained by the fact that the processes develop according to the principle of a “vicious” circle, when subsequent changes aggravate the cause of the process, and vice versa.

As a rule, all complications in the development of mountain sickness develop at night, during sleep, and by morning there is a significant deterioration in the condition. This is due to the horizontal position of the body, a decrease in respiratory activity, and an increase in the tone of the parasympathetic nervous system. Therefore, it is extremely important for a person with mountain sickness not to put them to sleep at a height, if possible, and to use every minute to transport the victim down .

The cause of death in cerebral edema is compression of the medulla by the vault of the skull, wedging of the cerebellum into the posterior cranial fossa. Therefore, it is very important to use both diuretics (reducing cerebral edema) and sedatives (sleeping pills) at the slightest symptoms of brain damage, because the latter reduce the brain’s need for oxygen.

With pulmonary edema, the cause of death is respiratory failure, as well as blockage of the airways (asphyxia) formed during swelling of the lung tissue foam. In addition to this, pulmonary edema in mountain sickness is usually accompanied by heart failure due to congestion of the pulmonary circulation. Therefore, along with diuretics that reduce swelling, it is necessary to give cardiac drugs that increase cardiac output, and corticosteroids that stimulate the heart and increase blood pressure.

In the work of the digestive system during dehydration, the secretion of gastric juice decreases, which leads to loss of appetite, disruption of digestion. As a result, the athlete loses weight dramatically, complains of discomfort in the abdomen, nausea, and diarrhea. It should be noted that digestive disorders in mountain sickness differ from diseases of the digestive tract, primarily in that the other members of the group do not observe signs of poisoning (nausea, vomiting). Such diseases of the abdominal organs as perforation of an ulcer or acute appendicitis are always confirmed by the presence of symptoms of peritoneal irritation (pain appears when pressing on the abdomen with a hand or palm, and sharply increases when the hand is withdrawn).

In addition, as a result of impaired brain function, visual acuity may decrease, pain sensitivity may decrease, and mental disorders may occur.

Symptoms

According to the time of exposure to hypoxia on the body, acute and chronic forms of mountain sickness are distinguished.

Chronic mountain sickness is observed in residents of high mountain areas (for example, the village of Kurush in Dagestan, 4000 m), but this is already the area of ​​activity of local doctors.
Acute mountain sickness usually occurs within a few hours and symptoms develop very quickly.
In addition, they distinguish subacute form of mountain sickness , which lasts up to 10 days. The clinical manifestations of acute and subacute forms of mountain sickness often coincide and differ only in the time of development of complications.

Distinguish between mild , moderate and severe degrees of mountain sickness.
For mild mountain sickness is characterized by the appearance of lethargy, malaise, palpitations, shortness of breath and dizziness in the first 6-10 hours after climbing to a height. It is also characteristic that drowsiness and poor falling asleep are observed simultaneously. If the ascent to altitude is not continued, these symptoms disappear after a couple of days as a result of the body’s adaptation to altitude (acclimatization). There are no objective signs of a mild form of mountain sickness. If these symptoms appear already 3 days after climbing to a height, the presence of some other disease should be assumed.

At an average degree of mountain sickness , inadequacy and a state of euphoria are characteristic, which are later replaced by a breakdown and apathy. Symptoms of hypoxia are already more pronounced: severe headache, dizziness. Sleep is disturbed: sick people fall asleep badly and often wake up from suffocation, they are often tormented by nightmares. During exercise, the pulse quickens, shortness of breath appears. As a rule, appetite completely disappears, nausea appears, and sometimes vomiting. In the mental sphere – there is a block on the route, poor or slow execution of commands, sometimes euphoria develops.
With a rapid loss of height, well-being immediately improves before our eyes.

In severe mountain sickness the symptoms of hypoxia affect all organs and systems of the body. The result is poor physical health, fatigue, heaviness throughout the body, preventing the athlete from moving forward.
Headache increases, with a sharp change in body position, dizziness and lightheadedness occur. Due to severe dehydration of the body, strong thirst is disturbing, there is no appetite, and gastrointestinal disorders appear in the form of diarrhea. There may be bloating, pain.
During nighttime sleep, breathing is disturbed (breathing is interrupted), hemoptysis may occur (hemoptysis is distinguished from bleeding by the presence of frothy sputum; gastric bleeding, as a rule, is never associated with a cough, and the blood coming from the stomach has the appearance of “coffee grounds” due to for interactions with hydrochloric acid of gastric juice).
When examining a patient: the tongue is lined, dry, the lips are cyanotic, the skin of the face has a grayish tint.
In the absence of treatment and descent down, mountain sickness leads to serious complications – swelling of the lungs and brain.
With pulmonary edema in the chest, mainly behind the sternum, wet rales, gurgling, gurgling appear. In severe cases, pink, frothy sputum may come out of the mouth when coughing. The pressure drops, the pulse quickens sharply. If treatment is not started immediately, the patient can die very quickly. Be sure to give the sick person a semi-sitting position to unload the heart and breathing, give oxygen, administer intramuscular diuretics (diacarb, furosemide) and corticosteroids (dexomethasone, dexon, hydrocortisone). To facilitate the work of the heart, tourniquets can be applied to the upper third of the shoulders and hips for 15-20 minutes. If the treatment is carried out correctly, the condition should improve quickly, after which an immediate descent should begin. If treatment is not carried out, as a result of an overload of the heart, heart failure quickly joins pulmonary edema: the skin turns blue, severe pains appear in the region of the heart, a sharp drop in blood pressure, arrhythmia.

Alpine cerebral edema differs from craniocerebral trauma primarily in the absence of asymmetry of the face, pupils and mimic muscles and is manifested by lethargy and confusion, up to its complete loss. At the very beginning of development, cerebral edema can be manifested by inappropriate behavior (anger or euphoria), as well as poor coordination of movements. Subsequently, the symptoms of brain damage may increase: the patient does not understand the simplest commands, cannot move, fix his eyes. As a result of cerebral edema, difficulty in breathing and cardiac activity may occur, but this occurs some time after the loss of consciousness. Cerebral edema is removed by fractional (repeated) administration of diuretics (diacarb, furosemide), the mandatory administration of sedatives or hypnotics, which reduce the brain’s need for oxygen, and the obligatory cooling of the victim’s head (a decrease in temperature by several degrees reduces cerebral edema and prevents the development of complications!) .

Prevention of mountain sickness

Climbers and mountain tourists planning climbing and hiking in the mountains should understand that the likelihood of mountain sickness in participants is reduced:

• good informational and psychological preparation,
• good physical condition,
• quality equipment,
• correct acclimatization and thoughtful climbing tactics.

This is especially important for high altitudes (over 5000 m)!

Good informational and psychological preparation

Be a bore in the best sense of the word. Find out thoroughly what the mountains are dangerous for, what the height is dangerous for. Now there is no problem to find any information on the Internet. And if you need an individual consultation with a specialist, then AlpIndustriya employees are at your service.

Good general physical training (GPP)

Prevention of mountain sickness consists, first of all, in the early creation of a good sportsman’s fitness at the stage of preparation for events in the mountains. With good general physical fitness, an athlete is less tiring, better resists the effects of cold, all his organs are prepared for high loads, including in the presence of oxygen deficiency. In particular, for athletes planning high-altitude ascents, it is mandatory to include anaerobic training in the training cycle (running uphill, running with a breath hold).

Sergey Kovalev, guide and leader of the expedition to the most beautiful peak of the Planet AmaDablam

Quality equipment industry”), bivouac equipment, equipment to ensure movement in the mountains – all these are factors that will save you from the cold (or heat, which even at altitude can sometimes “get” in the sun when there is no wind), allow you to move quickly and economically, provide a reliable and protected bivouac and hot food. And these are the factors of resistance to mountain sickness.
The “equipment” section should also include planning the correct selection of products: light, well-digestible, high-calorie, with good taste. By the way, when choosing products, it is advisable to take into account the taste preferences of each member of the group.
When making high-altitude ascents, it is obligatory to take multivitamins (preferably with a complex of microelements), antioxidants: tinctures of ginseng, golden root, rosea rhodiola, ascorbic acid, riboxin (in this case, it is desirable to carry out additional fortification of the body in advance, 1-2 weeks before leaving for the mountains ). Taking drugs that affect the pulse rate (potassium orotate, asparkam) in the mountains is not advisable due to the occurrence of various forms of cardiac arrhythmias. Be sure to take in the first aid kit means to normalize the water-salt balance (regidron) or drink slightly salted water.
Well, you should not forget about other medications in the first-aid kit, just as you should not forget to consult a doctor about its composition.

Proper acclimatization and thoughtful climbing tactics

Directly in the mountains, it is important to have good and correct acclimatization, moderate alternation of ascents to heights and descents to the place of lodging for the night with constant monitoring of the well-being of group members. At the same time, you should gradually raise both the height of the base camp and the height of the “peak” ascent points.
You can come across a situation where an “athlete”, tired of the office, finally escaped into nature – into the mountains, in this case – and decides to relax and “to sleep better” take a dose of alcohol.
So:
The tragic consequences of such a “relaxation” in history, even not so long ago, are known: this does not contribute to acclimatization at all, but vice versa.

Alcohol, even in small doses, is categorically contraindicated under conditions of hypoxia, as it depresses respiration, impairs interstitial fluid exchange, increases the load on the heart and increases the oxygen starvation of brain cells.

If, nevertheless, the disease has set in…

If one of the members of the group feels bad while climbing to a height, then in the case of a mild or moderate degree of illness, it can be overcome by smoother acclimatization, without forcing it. That is, to go down – to come to your senses – to rise higher, to look at your well-being, maybe even spend the night – to go down. And so on.

But the main thing is not to miss the symptoms of another disease (see above).

In case of a severe degree of illness, the victim must be immediately lowered down, since the condition can deteriorate greatly in a matter of hours, and the descent can become dangerous not only for the victim, but also for other members of the group. Maybe even at night…

The treatment of acute mountain sickness thus begins with the immediate descent of the ill participant to a lower altitude. The best remedy for increasing hypoxia is to increase the oxygen content in the air along with medication.

Mandatory when transporting a patient with mountain sickness are:

• drink plenty of water,
• administration of diuretics,
• with a sharp drop in pressure or deterioration of the general condition – intramuscular injection of corticosteroids.

(Hormones of the adrenal cortex – corticosteroids – have an adrenaline-like effect: increase pressure, increase cardiac output, increase the body’s resistance to disease).

Taking 1-2 aspirin tablets can give some effect in hypoxia – by reducing blood clotting, it contributes to a better delivery of oxygen to the tissues, but aspirin can only be taken if there is no bleeding or hemoptysis.

Alcohol in conditions of hypoxia is categorically contraindicated – we have already talked about this, and in case of illness – we emphasize: CATEGORICALLY!

Thus, saving the life of a person with altitude sickness will help:

• first, correct and rapid diagnosis of disease symptoms,
• secondly, the use of modern drugs to reduce hypoxia and prevent the development of severe complications,
• thirdly, the immediate descent of the sick participant of the ascent to a height that is safe for health.

Attention! The group leader must be well aware of the use of drugs in the group medicine cabinet and their contraindications! It is obligatory to consult with a doctor when completing!

Attention! Group members must be in good health (doctor’s clearance) and notify the leader in case of chronic diseases and allergies!

Attention! One more important point should not be forgotten. It may turn out that the strength and skills of your comrades will not be enough to evacuate you safely and quickly. And so that your family and friends do not have to raise funds for a helicopter or the work of professional rescuers, DO NOT FORGET ABOUT THE RIGHT INSURANCE POLICY!

Remember that when preparing for an ascent, you need to pay special attention to who you are going up the mountain with.

This may be a private guide, working illegally or semi-legally, who will offer a “sweet” price for his services. And in this case, if something goes wrong on the ascent, then who will be responsible for your life, safety and conflict resolution?

Prices for active tours for officially operating tour operators are not much higher than for clubs and private guides. And by choosing a company operating legally on the market, you get a number of advantages:

• Routes and programs carefully designed by professional guides.
• The guarantor of the fulfillment of obligations to you is not an individual, but a company that values ​​its reputation, has financial and legal responsibility to its customers.
• Official payments; a full package of documents and instructions that allow you to cooperate on equal terms and in legal security.
• Guides and experts are rigorously selected for professional training and ability to work with clients. By the way, AlpIndustriya, together with the FAR (Federation of Mountaineering of Russia), is the organizer of the international school of mountain guides in Russia. Education at the School is conducted according to the International Standard IFMGA/UIAGM/IVBV. Our country is supervised by the Association of Mountain Guides of Canada (ACMG). And school graduates work in Alpindustriya Tour.

In any case, the choice is yours.

Good and safe ascents to you!

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Kamil
10/16/2014

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Altitude sickness from A to Z. What is mountain climber? Symptoms, medicines, acclimatization. How to avoid? – Kuluar Tourist Club 💚

Friends, hello! Taras Pozdny is with you. I deal with altitude sickness to one degree or another all the time. Both personally, feeling myself while climbing 8000 m, and watching the participants, while working as a guide on trekking in Nepal. I decided to put together all my experience and structure the knowledge gained from lectures and the Internet.

Purpose: to write the most simple, understandable to anyone and at the same time complete article about altitude sickness and acclimatization. And also to answer most of the questions that I hear from the participants and which are regularly repeated, which means that they are of interest to the majority.

About miner in simple words. What is mountain sickness?

Mountain sickness (colloquially mountaineer) is a negative reaction of the body to altitude, caused by a lack of oxygen (hypoxia – oxygen starvation). In the mild stage, it is observed in almost everyone who rises to great heights. And in severe cases, it can lead to death.

What are the stages, symptoms and from what altitude mountain sickness begins, we will analyze below. And first, the disclaimer:

Everything below is based only on my personal experience and knowledge obtained from the Internet. Information should not be taken as an unshakable truth. Pass it through your experience, and before taking medication – consult your doctor.

Where does altitude sickness come from – a bit of theory

%. This is the norm to which we are accustomed.

As you climb, the atmospheric pressure decreases and the air becomes “thinner” – rarefied. This means that there are fewer oxygen molecules per unit volume. How much?

At the level of 5000 m it is about 50% of the norm, at the top of Everest it is 30-32%.

In practice, this means that in one breath we get less oxygen than we are used to. The first reaction of the body is to breathe more often and deeply. At low altitudes it works – stop, catch your breath. But if you immediately get to a high altitude (from 3000 m), then you will not be able to catch your breath, even while stationary. Hypoxia occurs – a lack of oxygen in the blood, brain and tissues. You start to die little by little.

“What about the Sherpas? After all, they live at high altitudes and feel great?” – you ask.

Fortunately, our body can adapt to the lack of oxygen. He just needs time. This process is called altitude adaptation or acclimatization and will be discussed below. But first, let’s take a look at the miner.

Will I get altitude sickness? Who is at risk?

At the bottom, it is impossible to tell if you will get altitude sickness. Everything is very individual. A more trained participant can cover already at 3000 m, and a less trained one will pass the track without any problems. It is possible to identify general theses and trends, but they are also very conditional:

• “Jocks” do not tolerate height well. Muscle piles that are used to consuming a lot of oxygen will be a hindrance to you. Therefore, high-altitudes are mostly taut.
• Girls tolerate height better. There is a possibility that for the same reason – on average, girls have fewer muscles that need to be supplied with oxygen.
• Height becomes easier to bear with age. Perhaps because in their youth everyone likes to walk quickly and the body does not have time to adapt. And with age, you begin to walk at a more measured pace.
• Past high altitude experience. Each time the height is transferred a little easier, the body roughly understands what needs to be done, and you are already more experienced and better acclimatized.
• Past negative experience. Do not worry too much, most likely, last time you had too fast acclimatization. But there is a chance that your body tolerates altitude worse and it will take longer.
• Altitude tolerance does not directly depend on your fitness level. Only indirectly, when a lack of oxygen is superimposed on an organism that is not accustomed to stress, you will not be envied. Therefore, it is necessary and worth training. Read: How to train for a hike in the mountains.

These are all just trends. Again, no one can say for sure in advance whether you will have altitude sickness. The athlete and the “office plankton” have the same chances.

The body’s normal response to altitude

When you enter a zone of high altitude (1500-3000 m), your breathing becomes faster and deeper. With standard physical exertion, severe shortness of breath appears. Fluid is retained in the body, which leads to swelling of the face and hands. It happens to everyone, so don’t worry.

Adaptation to new conditions begins: the number of erythrocytes (red blood cells that carry oxygen) increases, blood flow accelerates and at the same time the body learns to function in a more economical mode.

This takes time, which most of the time we don’t have. But there is a program schedule, a limited vacation, and no one will sit for months in order to calmly climb 5000. We continue to climb, and this will certainly lead to the appearance of a mild stage of altitude sickness.

Infographic: body’s reaction to altitude

Forms of altitude sickness and symptoms

Virtually everyone has symptoms of altitude sickness to one degree or another. But is it worth immediately panicking and starting the descent? Or can you keep going up? It all depends on the stage of the miner. Globally, there are three forms – acute mountain sickness (it is considered mild), pulmonary edema and cerebral edema. Let’s analyze each of them.

Acute mountain sickness (AMS, mide)

This is the first stage of altitude sickness, most often manifests itself 4-12 hours after falling to a height of 3000 m. It can have both a milder and very unpleasant form. The sensation is usually compared to a severe hangover, and yes – it really does feel like it.

The main symptom that signals the onset of a headache is a headache . It is usually accompanied by one or more of the following:

• Increased fatigue
• Lack of appetite
• Nausea and vomiting
• Apathy and unwillingness to do anything
• Poor sleep, insomnia

Also, hillyness can be diagnosed by the face: the skin turns pale, the lips turn blue, the look is a little lost.

All Couloir groups are equipped with pulse oximeters and every evening and morning we measure blood oxygen saturation. What is it and why is it needed – at the bottom of the article.

Covered. What to do with altitude sickness?

First of all, don’t panic and be afraid of a light mountain. Headache, increased fatigue and lethargy is observed in virtually everyone.

Secondly, you need to understand that there are no miraculous pills for mountain sickness. But you can help:

• Painkillers . If the head hurts only a little and not for long, you can do without pills. But in general, it is not recommended to endure a headache, and painkillers come to our aid. Ibuprofen and paracetamol perform well, they are often drunk in conjunction with aspirin – it thins the blood (but I don’t do that).
• Drink plenty of fluids . From three liters, while teas and soups are also considered.
• Diamax – if not taken, you can start, if taken – increase the dose. Below I will tell you in more detail.
• Abort climb . All three points will lead to nothing if you continue to quickly gain altitude. Usually, in 2-3 days at the same height, the body adapts, the symptoms either disappear or become milder.
• Sudden drop in altitude . If the symptoms are strong, you need to drop 500-1000 meters as soon as possible.

Most often there are situations when mountain sickness is in a moderated state and the group continues to move along the route. In this case, it is important to go as slowly as possible and unload the sick. If the daytime transition is not difficult, the climb is either absent or small (200-300 m), then usually nothing bad happens. It is important that there is a more experienced outside observer. In our groups, this is a guide, the team leader of the Couloir, who watches over each of the participants. Even experienced climbers cannot always adequately assess their own condition, and even beginners even more so.

If progressive mountain sickness is not recognized in time and recruitment is continued, it may develop into pulmonary and/or cerebral edema. And these are already critical conditions.

HIGH ALTITUDE PULMONARY EDEMA – HAPE

With each breath, air enters the lungs and then into small air pockets (alveoli). They have very thin walls with good conductivity. It is there that the blood is enriched with oxygen, after which it returns to the heart and further to all organs. At altitude, on the one hand, the pressure in the vessels increases, on the other hand, the permeability of the walls increases, as a result, our “air pockets” are filled with liquid. If there is liquid in the alveoli, then air cannot enter there and the blood is not enriched with oxygen. This is high altitude pulmonary edema. It can develop within 2-3 days after hitting a height.

Main symptoms of pulmonary edema:

• Increased shortness of breath. It is impossible to breathe even at rest. 1-2 meters, passed on a flat, cause circles before the eyes and stop for a minute or two to catch my breath. A person cannot go up at all. This is the first, simplest and most visible factor – so keep an eye on yourself and the team.
• Pulse can rise to 130-150, again at rest. In this case, saturation (oxygen content in the blood) can fall below 50%
• Fever, elevated body temperature – 38-39°C
• Blue lips and nasolabial triangle. Nails also turn pale/blue
• Heaviness in the chest area
• Severe dry cough, subsequently coughing up white-pink lumps of sputum
• Wheezing when breathing and gurgling sounds
• Vanka-stand-up syndrome. When you want to lie down because of fatigue, but as soon as you lie down, more water enters the lungs, you cough and sit down again. In this case, it is best to be in a semi-recumbent position.

What to do about high altitude pulmonary edema?

With pulmonary edema, we have from several hours to a day, so we act quickly.

The only “cure” is a quick drop in altitude of 1000 meters or more. All other measures are only temporary. Ideal – helicopter evacuation. That is why all participants of our high-mountain tracks have insurance, including helicopter evacuation. Read our recommendations for trekking and climbing insurance.

But often, for one reason or another, it is not possible to start an instant descent. Then:

1. Artificial oxygen . In the same Nepal, there are many lodges or medical centers.
2. Gamow bag – a bag where the victim is placed and in which pressure is built up, thus simulating a descent. It is usually used in combination with oxygen, but the thing is more rare.
3. Nifedipine is the first drug recommended for pulmonary edema
4. Dexamethasone is a steroid that can give the patient extra time.

But all this does not negate the fastest possible descent.

Alpine cerebral edema. HIGH ALTITUDE CEREBRAL EDEMA (HACE)

The methodology for the occurrence of cerebral edema has not yet been thoroughly studied. But the bottom line is that fluid enters the brain, the pressure on it increases and the supply of oxygen decreases. This causes severe headaches that are not relieved by painkillers.

A typical syndrome is “drunk behavior”:

• Incoherent confused speech
• Loss of coordination. You can do a test: draw a line so that the victim walks along it foot to foot – this will not work with swelling
• Strong apathy, indifference and unwillingness to do anything

Fortunately, swelling of the brain is rare. It usually occurs after an altitude of 4000 meters in less than 1% of tourists, but there have been cases of fixation at an altitude of 2100 m. Cerebral edema is preceded by an acute stage of mountain sickness, and it can be parallel to pulmonary edema. Only in exceptional cases has HACE been identified without previous symptoms of acute mountain sickness.

But what to do if you notice a “drunk” person?

Everything is about the same as with pulmonary edema – the fastest possible descent, at least 1000 m, the best is helicopter evacuation and hospital. While waiting for evacuation: dexamethasone, oxygen and Gamow bag.

Infographics: Forms, symptoms and first aid for mountain sickness

So, we have dealt with altitude sickness. We know how it appears, what are the stages, symptoms and what it is fraught with. And now let’s talk about how to avoid it, or at least make it as soft as possible – about acclimatization and what to do and what not to do at altitude.

Acclimatization – adaptation of the body to altitude

As soon as the body enters new conditions, it gradually begins to adapt to them. It takes time. In the mountains, as nowhere else, the rule works: “More quietly – you will continue.” The first important step is to draw up a proper acclimatization schedule. There are several basic rules:

• At an altitude above 3500 meters, do not gain more than 500 m per day (between overnight stays)
• Every 1000 m or three days, take a rest. Moreover, “rest” does not mean sitting still. This means to gain altitude radially and descend for the night to the same place.
• Walk higher – sleep lower. Arriving at the place of spending the night, go on an acclimatization walk. You need to dial about 150-200 meters, spend 20 minutes there and go down. Then you will sleep better.

There is an opinion that acclimatization lasts up to three weeks. But I have exceptions based on personal experience. In November-December 2016, I was at an altitude above 4000 in Nepal for a long time. Passed trekking to Everest, and then an expedition to Mera peak (6461 m) + Island peak (6189 m). After that, I was at home for two weeks, then trekking in Patagonia for 22 days at low altitudes. A week of rest – and my partner and I went to Aconcagua for the first time (6962 m). We decided to jump quickly, because he, too, a month and a half ago was at an altitude above 6000 m. As a result, climbing Aconcagua from the entrance to the national park to the exit took me 7 days. In fact, without acclimatization, with one night at 5050 and a start from Nido De Condores at 5500. At the same time, my partner was covered during the night at 5050 and I helped him descend to the base camp. Why is that? Because in Nepal I spent a long time at altitude and acclimatization was preserved even after almost two months. The partner was on Chimborazo (6384 m) and there the entire ascent takes three days – such acclimatization disappears very quickly.

The rule works: the longer you stay at altitude, the longer acclimatization lasts.

But, nevertheless, no matter how many eight-thousanders there are, each time you need to acclimatize anew. I am glad that each next time is a little easier.

How to feel better at altitude? Advice for everyone

• Drink plenty of fluids . Everyone is talking about it and for good reason. At altitude, the body loses water very quickly: you go to the toilet more often, breathe dry air (more moisture leaves with breathing), sweat from physical exertion. If on the plain it is recommended to drink about 2 liters of water per day, then at a height it should be at least 3, and preferably 4 liters. It can be both water and tea, juices and even soups.
• Give up alcohol, it dries out the body . And, given the point above, you are already dehydrated. During climbing and active acclimatization, I categorically do not recommend drinking alcohol. After you have reached the goal and started the descent, you can drink a jar of beer.
• Stop coffee . Caffeine raises blood pressure, makes the heart beat faster. At altitude, our heart beats faster than usual and the pressure is often elevated. It is better to give up coffee. At the same time, if you are a coffee addict and are used to drinking coffee several times a day, a sharp refusal can have a negative effect. Reduce the amount of coffee to one morning cup.
• Stay cool and don’t sweat . High-altitude trekking and mountaineering is the art of dressing up. Make sure you are as comfortable as possible. If it’s hot, stop and undress, walk slowly. It is very important not to sweat much, because there is a risk of quickly cooling down and getting sick. Don’t get cold, it’s always better to warm up. The body uses too much energy to keep warm.
• Walk slowly . Make sure that the pulse during the transition is in the range of 110-130 beats / min. Not more. With a higher heart rate on transitions, you will be overtired and have no time to recover. Of course, in steeper sections, the pulse may briefly increase.
• Use sunscreen and lip balm. To burn out in the sun is to add stress to the body, which is already enough
• Get enough rest . Do not sit up in the evenings until midnight, get enough sleep
• Smoke less . If you smoke, we recommend reducing your dose a few weeks before the start of the program and smoking as little as possible at altitude. It can be very stressful for a heavy smoker to give up cigarettes completely, it is not necessary to do this on the program.

Our task is to minimize the amount of stress and unnecessary stress for the body.

Infographic: Acclimatization. What to do to make it easier to bear height

Sleep at height

Dreams at height are more vivid and vivid than below. At least for me. Maybe because the sleep is less deep and during the night I can wake up three to five times and fall asleep again. This is fine.

If you suffer from insomnia, you can take half a tablet of Diamax. You can also take the sleep hormone Melatonin. I do not recommend ordinary sleeping pills, it is believed that they worsen acclimatization. Some climbers take cinnarizine before bed for headaches.

Another phenomenon that I want to talk about is periodic breathing, the so-called Cheyne-Stokes breathing.

At altitude, we breathe deeply and frequently, which reduces the concentration of carbon dioxide (CO2). Namely, its excess stimulates the respiratory center. When we are awake, consciousness gives signals to inhale, and when we fall asleep, it stops. As a result, there is no excess CO2 and no breath signal is given. There is a holding of breath for 10-15 seconds, then awakening from a lack of oxygen and a series of intense breaths follows. It feels like you wake up from the fact that you started to choke and try to breathe. An extremely unpleasant, but not critical phenomenon that many people experience.

Once you have recovered your breath, you can sleep peacefully.

Mountain sickness pills

Mountain sickness pills do not exist, and we already know that there is only one cure – a quick descent. But there are pills that will help you acclimate better.

I won’t go into the topic of ethical use of medicines (as well as artificial oxygen at 8000), but I will simply say – if you are not an athlete and you have nothing to prove to others or yourself, then do your best to get the most pleasant sensations from the track / ascent, and do not suffer from the mountain.

Acetazolamide, Diamox, Diacarb

Acetazolamide, Diamox, Diacarb is all the name of one drug.

It is noteworthy that in the post-Soviet space there are still disputes about its effectiveness as a prophylactic, while in the Western world it is strongly recommended. From personal experience and observations of hundreds of participants: Diamax really helps to better acclimatize.

Diamax is a diuretic that lowers intracranial pressure, which eliminates the symptoms of neck pain, promotes easier and faster acclimatization.

At the same time, there is no “rollback” effect, that is, if you stop taking the drug, nothing bad will happen.

How to take Diacarb (Diamax)

Start taking the day before going to 3000 m. The standard dose is 250 mg – this is one tablet. It is better to take in the morning. If we feel that it still covers – the dose can be increased to two tablets. One in the morning, the second in the late afternoon. At the same time, we remember that Diacarb is a diuretic, I do not recommend drinking later than two hours before bedtime. Otherwise, you will run to the toilet all night and not get enough sleep, which is also bad. It is not recommended to take more than 3 tablets per day.

At altitude you already lose a lot of fluid, and with Diacarb even more, so we drink more water. Minerals and salts, in particular potassium and magnesium, are washed out with urine. Therefore, it is recommended to take Panangin or Asparkam in parallel with Dicarb – 1-2 tablets 2-3 times a day.

Be prepared that after about a day of taking Diacarb you will begin to tingle in your extremities – fingers and toes, even your nose, teeth and feet may become numb and itchy. In addition, Diakarb has one more property – it changes the taste of carbonated drinks.

Half a tablet can be taken at night if you have trouble sleeping.

We stop taking Diamax on the day when we have reached the maximum height and start descending.

Whether or not to accept Diamax is up to you, I recommend it to all participants who want to transfer height more gently.

Other medicines you may need

Vitamins . Two weeks before leaving for a height, it is good to start drinking a vitamin complex. We need Potassium, Magnesium, Calcium, B vitamins and vitamin C. The effervescent tablets that dissolve in water performed well on the track.

Ibuprofen, paracetamol are the best remedies for headaches. The normal dose is two tablets per day. Often recommended in tandem with Aspirin, as it thins the blood.

Dexamethasone is a steroid found in the group medicine cabinet. As a last resort in case of high altitude pulmonary and/or cerebral edema.

How much oxygen is in my blood? Measuring Saturation

Saturation is the saturation of the blood with oxygen and now it can be measured with a small device that each of our guides on high-altitude programs has – a pulse oximeter.

We take measurements twice a day – in the morning and in the evening. We look not at absolute indicators, but at the dynamics.