A. M. S. (ACUTE MOUNTAIN SICKNESS)

There is so much less oxygen in the high mountains that it is not surprising that travelling to high altitude causes people to feel unwell, but how this shortage of oxygen actually leads to altitude sickness is still not fully understood. Most people remain well at altitudes of up to 2500m, the equivalent barometric pressure to which aeroplane cabins are pressurised. However, even at 1500m above sea level you may notice more breathlessness than normal on exercise and night vision may be impaired. Above 2500m, the symptoms of altitude sickness become more noticeable.

In fact the term “altitude sickness” can be used to describe any altitude-related illness. There are three forms of altitude sickness that can affect people very quickly after they have ascended to high altitude.

Tibet is sometimes known as the ‘roof of the world’. The high plains over which you will travel on your overland trip from Kathmandu to Lhasa average 11000 to 13000 ft, while some of the mountain passes are over 18000 ft (5.220 Mt.). At such high altitudes, there is a chance of having symptoms of mountain sickness. Because this trip is by bus rather than foot (there fore without much physical exertion), these mountain sickness symptoms usually do not become severe. Nonetheless, one should know about the symptoms and treatment of altitude sickness.


Altitude sickness:
At sea level, a whole atmosphere of pressure pushes in on the air one breathes. As one goes higher and higher, there is less atmosphere and hence less atmospheric pressure pushing in on the air breathed in to the lungs. Human bodies experience that lack of air pressure as a lack of oxygen. Until the body has a chance to adapt, one may experience symptoms of mountain sickness. Different people’s bodies adapt or acclimatize at different rates. These acclimatization rate are not at all related to what kind of physical shape one is in. for example, an Olympic marathon runner and or an obese, remote control TV watching couch potato are equally likely to have symptoms of altitude sickness at the same altitude.

Symptoms of A. M. S. – The symptoms of altitude sickness are rather vague, variable, and easy to attribute to other causes. However, when at high altitude, assume any of the following symptoms are mountain sickness until proven otherwise.

Symptoms of Ams

Mild	Moderate	Severe
Headache	severe headache	altered
Nausea	vomiting	consciousness
Malaise	dizziness	poor judgment
Low appetite	irritability	shortness of breath
Sleeplessness	dry cough	wet cough
	Little urination	coughing blood
		Unable to walk

If you have symptoms:

• Rest – do not over exert yourself

• Do not go higher.

• Drink lots of fluids. Avoid alcohol.

• let someone know how you are feeling

• Try aspirin or paracitamol for headache discomfort

• Avoid any sedatives – especially sleeping pill or narcotics. These medicines eill slow your breathing and worsen your symptoms.

• Consider use of acetazolamide (Diamox) to prevent or treat symptoms.

• If symptoms are severe or worsening, return to lower altitude.

• With the help of a physician, consider the use of other medicines such as Dexamethasome every 6 hours, Nifedipine 10 mg every 8 hours and or oxygen. Acetazolamide (Diamox)

If AMS symptoms are moderate or severe, or mild symptoms are getting worse, acetazolamide treatment may be beneficial. The dose is 250 mg every 12 hours. This medicine stimulates breathing and therefore helps the body get more oxygen. Acetazolamide especially helps one breath better at night and hence, helps sleep without causing any sedating effects. Possible side effects of acetazolamide include tingling (pins and needles feeling) of hands, Toes or lips. Increased urination, and change in taste of carborated beverages. These symptoms are merely annoyances, resolve when the drug is stopped, and do not indicate allergic reactions, travelers who have allergies to sulfa antibiotics and have never tried acetazolamide should not take this medicine, acetazolamide is as sulfa derivative, there is a slight possibility of allergic cross reaction.

Prevention – Besides acting to treat symptoms of mountain sickness, acetazolamide can also help prevent or decrease severity of AMS symptoms before they occur. The overland journey from Kathmandú to Lhasa covers much altitude in a short period of time. I.e. traveling from Zhangmu to Xegar Dzong in one day gains 2,050 mt of altitude. The best way to avoid AMS is to ascend slowly. This is not possible in a week long trip from Kathmandú to Lhasa. Therefore it is quite reasonable to take 125 – 250 mg of acetazolamide 2 times per day 24 hours before ascending to high altitude to prevent mountain sickness. Diamox may be continued until one acclimatizes or stops going higher.

Especially for people who have been to high altitude before and have had AMS, taking acetazolamide 24 hours before going high is very helpful in preventing altitude sickness. Drinking lots of water while taking acetazolamide is very important, since, acetazolamide makes one urinate more.

Most people do just fine at high altitude with nothing more than a few annoying symptoms of headache or shortness of breath with exertion. Being able to identify know what to do about mountain sickness can help prevent serious problems

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