There are a variety of conditions that can occur when going into high altitudes and, as with most things, prevention is the best option.
Only a few of the more severe and/or more common conditions are detailed here. As a ‘cure-all’, if someone gets sick and you can’t figure it out, you should descend.
General Prevention of Altitude Induced Illnesses
Do not consume alcohol.
Maintain adequate hydration and nutrition (a 70% carbohydrate diet may help).
Take the time to acclimatize.
Train for endurance and strength before going to high elevations.
Make day trips to a higher altitude with a return to lower altitude for sleep.
Mild exercise may be helpful, but extreme exercise may have the opposite effect.
Above 3000 m (10 000 ft.) ascend no more than 1000 m (3000 ft.) in a 24 hour period, and have a rest day. Rest every 2 to 3 days.
Acetazolamide can be taken 24 hours before the ascent and during until acclimatization has occurred, which is usually after 48 hours at the maximum altitude.
Dexamethasone is another option for those that can’t take acetazolamide, but it has a greater chance of causing side effects.
Ibuprofen may help. Administer until the highest altitude is attained for 48 hours.
Rapid change in elevation may cause a condition known as altitude sickness or acute mountain sickness (AMS).
AMS occurs most commonly when approaching 2400m (8000 feet) above sea level although there are many cases of AMS occurring at lower altitudes. It is usually aggravated by exertion.
Mild AMS most commonly occurs at altitudes over 2500 m (8000 ft.)
Symptoms are similar to being hung-over and include:
Dizziness.
Headache (often precluding AMS).
Increased heart rate.
Insomnia.
Fatigue.
Lack of appetite.
Nausea.
Pins and Needles/tingling.
Shortness of breath.
Vomiting.
Chest congestion.
Confusion.
Cough that may produce blood and/or phlegm.
Cyanosis (blue, gray or purple discoloration of the skin).
Dehydration.
Indifferent behavior.
Loss of coordination.
Unconsciousness.
Avoid narcotics.
Maintain hydration and nutrition.
Stop ascending.
Descend if symptoms do not dissipate after 24 hours.
Pharmaceuticals:
Acetazolamide: 200 mg orally every 8 hours, maximum 1 gram/day.
Dexamethasone: 3 mg/8 hours.
Nausea medications.
High-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE) occur when the high-altitude causes edema in the lungs (pulmonary) or brain (cerebral).
Edema is basically an accumulation of fluid resulting in swelling.
Both HAPE and HACE can be life threatening, and they can occur together. Treatment for both is the same.
Cough: mild and dry to begin, becoming more productive in later stages.
Cyanosis (blue, gray or purple discoloration of the skin).
Increased pulse and respiratory rate.
Fatigue.
Fluid in lungs resulting in a gurgling sound (rales).
Mild fever.
Shortness of breath.
Weakness.
Confusion.
Decreased consciousness.
Hallucinations (rare).
Lethargy.
Seizures (rare); Diagnoses and Treatments – Head – Brain – Seizures.
Severe headache.
Vomiting.
Descend as much as possible, at least 500m.
PROP; Must Read - Immediate First Aid - Primary Assessment Detailed – Breathing.
Consider hyperbaric bag, preferably after descent.
Pharmaceuticals:
Acetazolamide: every 8 to 12 hours and reduce dosage as symptoms decline.
Dexamethasone: 4 mg every 6 hours until at safe elevation.
Nifedipine (Procardia): for HAPE. 20 mg every 6 to 8 hours. Note: will lower blood pressure.
Sildenafil (Viagra): helps to treat HAPE.
Inhaled beta-agonists, e.g., Salmetero: helps to treat HAPE.
Acetazolamide: start a couple of days before the planned ascent.
Dexamethasone: HAPE preventative, 4 mg every 12 hours.
Nifedipine (Procardia): HAPE preventative, 20 mg every 6 to 8 hours, Note: will lower blood pressure.
Sildenafil (Viagra): HAPE preventative.
Inhaled beta-agonists, e.g., Salmetero: HAPE preventative.
Alternative/Natural Remedies:
Ginkgo Biloba.
High -altitude flatus expulsion (HAFE) is the occurrence of flatulence as a result of high-altitude. It is an inconvenience but generally harmless.
Carbohydrate diet.
Descent.
Pharmaceuticals:
Simethicone: 80 mg.
High-Altitude Pharyngitis and Bronchitis
High-altitude pharyngitis and bronchitis usually occurs at over 2400 m (8000 ft.).
Symptoms of High-Altitude Pharyngitis and Bronchitis
Chronic cough which can be either dry or productive.
Dry or cracking nasal passages.
Reddened and painful throat.
Treatment for High-Altitude Pharyngitis and Bronchitis
Hydration.
Lozenges or hard candies.
Nasal saline spray.
Steam inhalation.
Pharmaceuticals:
Albuterol (common asthma medication).
Peripheral edema is swelling of the soft tissues, usually in hands, face and ankles.
Treatment for Peripheral Edema
Will self-resolve when patient is acclimatized.
Examine for AMS, HAPE, or HACE; Diagnoses and Treatments – Environmentally Induced – Altitude Induced.
Pharmaceuticals:
Acetazolamide: 125 to 250 mg.