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Altitude sickness has three forms: Acute Mountain Sickness (AMS), High Altitude Pulmonary Edema (HAPE), and High Altitude Cerebral Edema (HACE). Let’s talk about each of them, their symptoms and how to prevent them.
What is Altitude Sickness?
Acute mountain sickness (AMS) is the effect on the body of being in a high altitude environment. AMS is common at high altitudes, that is above 8,000 feet (2,440 meters). Three-quarters of people have mild symptoms of AMS over 10,000 feet (3,048 meters). The occurrence of AMS depends on the altitude, the rate of ascent, and individual susceptibility.
Mild altitude sickness is called acute mountain sickness (AMS) and is quite similar to a hangover – it causes a headache, nausea, and fatigue. This is very common: some people are only slightly affected, while others feel awful. However, if you have AMS, you should take this as a warning sign that you are at risk of the serious forms of altitude sickness: HAPE and HACE. Both HAPE and HACE can be fatal within hours.
Mild AMS does not usually interfere with normal activity and symptoms generally subside within 2-4 days as the body acclimatizes. As long as symptoms are mild, and only a nuisance, ascent can continue at a moderate rate. However, it is important to not ignore these initial symptoms. When hiking, it is essential to communicate any symptoms of illness immediately to others on your trip. If they worsen, your life could be in serious danger.
What causes altitude sickness?
Two things are certain to make altitude sickness very likely – ascending faster than 1500ft per day and exercising vigorously. Physically fit individuals are not protected – even Olympic athletes get altitude sickness. Altitude sickness happens because there is less oxygen in the air that you breathe at high altitudes.
Because altitude sickness is caused by too rapid of ascension, it is important to slowly acclimatize to the altitude.
Altitude sickness prevention
Go up slowly, take it easy, and give your body time to get used to the altitude. The body has an amazing ability to acclimatize to altitude, but it needs time. For instance, it takes about a week to adapt to an altitude of 16000ft.
If you begin to notice the signs of altitude sickness, it is always safer to descend to a lower altitude. When the more serious forms of altitude sickness, HAPE and HACE, set in, the only cure is immediate descent.
It is never worth it to risk someone’s life “just make it to the next peak” or “spend one more night on the mountain” if you or a companion is experiencing the symptoms of AMS, HAPE, or HACE.
Another prevention method is to always have a satellite phone with your group when you go hiking. Satellite phones are much more reliable at high altitudes than standard cell phones. It is much more likely that medical aid will rescue a victim in time to save their life if they are contacted in time. Don’t get stuck in a situation where your only means of communication is a cell phone that doesn’t have service. If you or a companion is experiencing HAPE or HACE, help can be just a radio call away, ready to meet you as you descend.
AMS, HAPE, and HACE
Like we mentioned earlier, there are three varying degrees of altitude sickness: AMS, HAPE, and HACE. Each form of the illness is more life-threatening than the former. Learn how you can prevent mild forms of altitude sickness from developing into its fatal counterparts.
Acute Mountain Sickness (AMS)
Mild altitude sickness is called acute mountain sickness (AMS) and many describe it as very similar to a hangover or the flu – it causes a headache, nausea, and fatigue. This form of altitude sickness is very common and some people are only slightly affected, while others feel awful. However, if you have symptoms of AMS, you should take this as a warning sign that you are at risk of developing the serious forms of altitude sickness: HAPE and HACE.
Most people remain healthy at altitudes of up to 8000ft, the equivalent barometric pressure to which airplane cabins are pressurized. However, even at around 5000ft above sea level, you may notice more breathlessness than normal while exercising and night vision may be impaired. Above 8000ft, the symptoms of altitude sickness become more noticeable and more dangerous.
High Altitude Pulmonary Edema (HAPE)
HAPE develops from AMS and is a dangerous build-up of fluid in the lungs that prevents the air spaces from opening up and filling with fresh air with each breath. When this happens, the sufferer becomes progressively more short of oxygen, which in turn worsens the build-up of fluid in the lungs. Because of this, HAPE can be fatal within hours.
HAPE usually develops after 2 or 3 days at altitudes above 8000ft. Typically, the sufferer will be more breathless compared to those around them, especially during exertion. Most will have symptoms of acute mountain sickness (AMS). Often, they will have a cough and this may produce white or pink frothy mucus. The breathlessness will progress and soon they will be breathless even at rest. Heart rate may be fast, the lips may turn blue and body temperature may be feverish. It is easy to confuse symptoms of HAPE with a chest infection, but at high altitudes, HAPE must be suspected and the affected individual must be evacuated to a lower altitude.
It is never normal to feel breathless when you are resting – even on the summit of Everest. This should be taken as a sign that you have HAPE and are at serious risk of death.
High Altitude Cerebral Edema (HACE)
HACE is a build-up of fluid in the brain. It causes confusion, clumsiness, and stumbling. The first signs may be uncharacteristic behavior such as laziness, excessive emotion, or violence. Drowsiness and loss of consciousness occur shortly before death.
HACE is the most severe form of acute mountain sickness. A severe headache, vomiting, and lethargy will progress to unsteadiness, confusion, drowsiness, and ultimately coma. HACE can kill in only a few hours. A person with HACE will find it difficult to walk heel-to-toe in a straight line – this is a useful test to perform in someone with severe symptoms of acute mountain sickness. HACE should also be suspected if a companion starts to behave irrationally or bizarrely.
Descent is the most effective treatment of HACE and should not be delayed if HACE is suspected.
Treatment of HAPE and HACE
To treat HAPE and HACE, immediate descent is absolutely essential.
Other treatments can work to buy time for the victim but are often difficult to obtain. These include:
- Dexamethasone and acetazolamide, which should both be given, if available
- Pressure bags and oxygen gas, which can buy time
It is better to prevent acute mountain sickness than to try to treat it. Following the golden rules should mean that your body can acclimatize as you ascend so you will be less likely to develop acute mountain sickness.
With any form of altitude sickness, the best treatment is descent. Just go down before it gets any worse.
- Acute mountain sickness (AMS) is the effect on the body of being in a high altitude environment.
- Mild altitude sickness is called acute mountain sickness (AMS). If you have symptoms of AMS, a headache, nausea, and fatigue, descend immediately.
- HAPE develops from AMS and is a dangerous build-up of fluid in the lungs that prevents the air spaces from opening up and filling with fresh air with each breath. The symptoms are breathlessness, fatigue, nausea, fever, and mucus when coughing. HAPE can be fatal within hours. The only treatment is immediate descent and medical care.
- HACE is a build-up of fluid in the brain and is the most severe form of acute mountain sickness. The symptoms are a severe headache, vomiting, and lethargy which will progress to unsteadiness, confusion, drowsiness, and ultimately coma. HACE can kill in only a few hours. The only treatment is immediate descent and medical care.
- Satellite phones can increase the chance of medical help rescuing a victim in time.
- It is better to prevent acute mountain sickness than to try to treat it. Just go down!
This may seem like a lot of information to take in, but when it comes to saving lives, a little extra care spent learning prevention methods always pays off.
We can help you get a better understanding of how to prevent altitude sickness in all its forms. Attend one of our quarterly altitude sickness trainings at the Orem Scout Office.
Author: Madison Austin | Marketing Specialist, Utah National Parks Council