Preventing and Treating High Altitude Sickness

One of my family’s most enjoyable vacations included a few days spent at Rocky Mountain National Park.  While animal watching is a favorite activity no matter where we go, RMNP is known for its hiking trails, stellar mountain views, and crossing the Continental Divide.  With altitudes above 11,000 feet, the air is clear and you can see forever.  The visual experience is exquisite. 

Unfortunately, developing altitude sickness can make you wish you’d never left home.

Many Americans aren’t too excited about the socialist utopia the budding overlords wish to develop here.  In fact, they’ve made plans to “bug out.”  I’m not sure it’s the best idea, but to each his own.  Some people have land and cabins and caches.  Others are established at lower elevations but have escape routes to higher ground should it be required.  Even as we set up our little homestead here at 6400 feet above sea level, if the invaders decide to come our way, we also would be scaling the mountains in our backyard to wait things out.

Up to half the people who ascend above 8000 feet may develop high altitude sickness, with the risk being greater for those reaching higher altitudes at a faster pace.  Symptom onset may begin within a few hours or up to a few days.[1]  Because high altitude sickness can be life-threatening and will certainly make further physical exertion risky and nearly impossible, we need to be prepared to prevent, recognize, and treat this condition. 

High altitude sickness, also known as acute mountain sickness, most frequently develops when an individual rapidly ascends a mountain without taking time to become gradually acclimated to the new conditions, and usually at elevations above 8000 feet.  Most of the time, altitude sickness is a temporary inconvenience, but some people develop edema (swelling) of the brain or lungs, both of which are life-threatening conditions.

Prevention

• Ascend in altitude as gradually as possible, ideally less than 2000 feet per day 
• People should not over-exert themselves
• Drink plenty of fresh water
• Avoid alcohol
• Eat lots of carbohydrates
• Ibuprofen, 600 mg, 3 times per day[*]
  

Acetazolamide (Diamox) is a prescription-only medication used for both prevention and treatment.  As a diuretic, it eliminates excess fluids from the body, helping prevent the accumulation of fluids and subsequent edema of the lungs and brain.  It is best begun before the planned ascent, if possible.  Dosages range from 125 to 1000 mg per day.  It is available through All Day Chemist.

Keep in mind that altitude sickness can occur even in healthy people at altitudes below 8000 feet. 

Mild symptoms include:

• Fatigue
• Insomnia
• Headache
• Nausea and vomiting
• Decreased appetite

Severe general symptoms include:

• Loss of coordination
• Loss of consciousness
• Dehydration[2]

Severe pulmonary edema

• Coughing up blood
• Cyanosis of the fingertips and lips
• Severe shortness of breath
• Cough and chest congestion[3]

Severe cerebral edema

• Confusion, apathy
• Loss of consciousness[4]

The best and most effective and urgent treatment for high altitude sickness is to move the patient down the mountain, if possible, or simply rest.  While gingko biloba extract is often recommended for preventing and treating high altitude sickness, clinical trials do not support its usage in this situation.[5]

 

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[1] David Murdoch, “Altitude sickness,” BMJ Clinical Evidence, 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907615/ (accessed 3 March 2021).

[*] Acute altitude illness:  Updated prevention and treatment guidelines from the wilderness medical society, American Family Physician, Vol 101 No 8, 15 April 2020, https://www.aafp.org/pubs/afp/issues/2020/0415/p505.html (accessed 9 May 2023).

[2] David Murdoch, “Altitude sickness,” BMJ Clinical Evidence, 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907615/ (accessed 3 March 2021).

[3] David Murdoch, “Altitude sickness,” BMJ Clinical Evidence, 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907615/ (accessed 3 March 2021).

[4] David Murdoch, “Altitude sickness,” BMJ Clinical Evidence, 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907615/ (accessed 3 March 2021).

[5] Jeffrey Gertsch, et al., “Randomized, double blind, placebo controlled comparison of gingko biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers:  the prevention of high altitude illness trial,” BMJ, April 2004, https://pubmed.ncbi.nlm.nih.gov/15070635/ (accessed 3 March 2021).

06.21.23