Some Useful Information for Travelers on High-Altitude Treks in Nepal

Altitude Sickness, often known as Acute Mountain Sickness (AMS), is a particularly important medical consideration while trekking in Nepal. Altitude Sickness means the effect of altitude on those who ascend too rapidly to elevations above 3,000 meters. Anyone may be affected by AMS regardless of strength or physical fitness. There are two types of Altitude Sickness, high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE)

High-Altitude Cerebral Edema

When AMS becomes life-threatening, it is called high-altitude cerebral edema (HACE). HACE symptoms include vomiting, lethargy, confusion, drowsiness, loss of coordination, and coma. The condition can become fatal after a few hours or a few days. Because the hallmark of HACE is the impairment of cognitive ability, a person with HACE may be too impaired to realize what is wrong with him and to properly evaluate his situation. According to, anyone behaving irrationally or bizarrely should be suspected of suffering from HACE.

High-Altitude Pulmonary Edema

AMS and HACE are the products of an oxygen-starved body. A different sort of high-altitude sickness is high-altitude pulmonary edema, or HAPE. This illness is the result of low air pressure causing a fluid build-up in the lungs. The condition can be fatal within just a few hours. HAPE is easily confused with AMS or HACE and a person can suffer from HAPE and ACE/HACE at the same time. HAPE symptoms include lethargy, shortness of breath while resting or fast, shallow breathing, gurgling breaths, cough with pink, frothy sputum, tightness or congestion of the chest, drowsiness, and blue or gray lips and/or fingernails.

The initial symptoms of AMS are as follows:

  1. Nausea/Vomiting
  2. Loss of appetite
  3. Insomnia/Sleeplessness
  4. Persistent headache
  5. Dizziness, light heaviness, confusion, disorientation, drunken gait
  6. Weakness, fatigue, lassitude, heavy legs
  7. Slight swelling of hands and face
  8. Breathlessness and breathing irregularity
  9. Reduced urine output

These symptoms are to be taken very seriously. In case of the appearance of any of the above symptoms, any further ascent should be reconsidered. More serious problems can occur which can even cause death sometimes within a few hours. The main cure for Altitude Sickness is to descend to lower elevations immediately. Acclimatization by ascending to no more than 300 to 500 meters per day above 3,000 meters and the proper amount of rest are the best methods for the prevention of AMS. The literature and pamphlet published by the Himalayan Rescue Association (see Rescue Service below) consists of detailed information on AMS. The Central Immigration Office and all trekking agencies in Kathmandu distribute this pamphlet free of cost. Since these documents also give information on the list of suggested medical supplies for trekkers, it is a compulsory item for every trekker’s medical kit

Prevention of Acute Mountain Sickness

  1. If Possible, Don’t Fly Or Drive To High Altitude. Start Below 3,000 Metres (10,000 Feet) And Walk Up.
  2. If You Do Fly Or Drive, Do Not Overexert Yourself Or Move Higher For The First 24 Hours.
  3. If You Go Above 3,000 Metres (10,000 Feet), Only Increase Your Altitude By 300 Metres (1,000 Feet) Per Day, And For Every 900 Metres (3,000 Feet) Of Elevation Gained, Take A Rest Day To Acclimatise.
  4. Climb High And Sleep Low! You Can Climb More Than 300 Metres (1,000 Feet) In A Day As Long As You Come Back Down And Sleep At A Lower Altitude.
  5. If You Begin To Show Symptoms Of Moderate Altitude Sickness, Don’t Go Higher Until Symptoms Decrease.
  6. If Symptoms Increase, Go Down, Down, Down!
  7. Keep In Mind That Different People Will Acclimatise At Different Rates. Make Sure Everyone In Your Party Is Properly Acclimatised Before Going Any Higher.
  8. Stay Properly Hydrated. Acclimatization Is Often Accompanied By Fluid Loss, So You Need To Drink Lots Of Fluids To Remain Properly Hydrated (At Least Four To Six liters per Day). Urine Output Should Be Copious And Clear To Pale Yellow.
  9. Take It Easy And Don’t Overexert Yourself When You First Get Up To Altitude. But, Light Activity During The Day Is Better Than Sleeping Because Respiration Decreases During Sleep, Exacerbating The Symptoms.
  10. Avoid Tobacco, Alcohol, And Other Depressant Drugs Including, Barbiturates, tranquilizers, Sleeping Pills, And Opiates Such As Dihydrocodeine. These Further Decrease The Respiratory Drive During Sleep Resulting In A Worsening Of Symptoms.
  11. Eat A High-Calorie Diet While At Altitude.

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