Acute Mountain Sickness (AMS)

Travelling to higher altitudes in excess of 3000 mtrs means you have to be prepared for AMS or Acute Mountain Sickness.

Q. What the hell is AMS?

AMS or Acute Mountain Sickness is a generic term used to denote a host of sicknesses resulting due to improper acclimatization on higher altitude. This is also known as altitude sickness, hypobaropathy or soroche. In severe forms, AMS may result in HAPO/HAPE (High Altitude Pulmonary Oedema/Edema** – swelling of lungs due to fluid deposit) and HACO/HACE (High Altitude Cerebral Oedema/Edema** – swelling of brain due to fluid deposit). Quite often, dehydration and increased RBC count is also associated. Of these, HAPO/HAPE and HACO/HACE prove to be fatal if not treated immediately.

** Oedema (British English) and Edema (American English) are same terms to denote accumulation of fluids in body parts

Q. Why does it happens?

People like us, who live in plains and generally at not much altitude to the mean sea level (MSL), are used to breathe in a particular way where our breaths are shorter. This is because of high atmospheric pressure which results in concentration of oxygen in the atmosphere and hence even with shorter breaths, our body is able to cope with the oxygen demand.

At higher altitudes, the atmospheric pressure is less and hence oxygen is rarefied. We need frequent, deeper and longer breaths to inhale the same amount of oxygen into our lungs as per the body demands. This also results in loss of body fluids in form of vapours and causes dehydration also. The count of Red Blood Cells (RBCs) in our blood also increases to carry more and more oxygen to the cells.

Q. How do I know someone has been hit by AMS? What are the symptoms?

The primary and common symptoms that manifests in majority of people are:

• Acute Headache
• Nausea and Vomiting

Other symptoms may also be manifested, which include:

• Fatigue
• Lack of Apetitie
• Dizziness
• Insomnia
• Bleeding nose
• Paresthesia (commonly called Pins and Needles) – sensation of tingling, tickling, prickling, pricking, or burning of a person’s skin with no apparent long-term physical effect
• Persistent rapid pulse
• General feeling of uneasiness
• Memory loss
• Mood swings
• Blue color to the skin (cyanosis)

Critical symptoms which require immediate evacuation to lower altitude and treatment include:

• HAPE/HAPO, identified by
  • Bronchitis kind of symptoms – acute cough with or without mucus/sputum
  • Persistent dry cough
  • Fever
  • Loss/shortness of breath even while resting
• HACE/HACO, identified by
  • Headache that doesn’t responds to analgesic medicine
  • Unsteady gait
  • Loss of consciousness
  • Increase nausea
  • Retinal haemorrhage

Q. What are the preventive measures?

• The best preventive measure know to man is to ascend slowly. There are 4 Rules of Climb:
  1. Spend AT LEAST one night at an altitude below 3000 meters
  2. Once you are above 3000 meters of altitude, DO NOT increase your sleeping elevation more than 300-500 meters per night.
  3. For every 1000 meters of elevation, spend TWO NIGHTS at the same elevation
  4. Hike higher, Sleep lower

• Drink adequate water, frequently and take as many bio-breaks. However, please note that doing so also results in loss of essential body salts. Hence, keep the water mixed with WHO ORS solution. Avoid over-hydration. Thumb rule: 2 sips of water every half an hour.
• Garlic juice, mixed with water is known to work wonders.
• Camphor when placed in the nostrils is also known to be effective.
• Eat regular meals, preferably rich in carbohydrates.
• AVOID smoking, alcoholic drinks, narcotics based drugs (and narcotics of course!) and sleeping pills
• AVOID too much of strenuous activity that causes fatigue
• Keep warm. Do not overexpose to the cold
• Do not spend more than 20 minutes at high mountain passes

Q. Aren’t there any drugs/medicine that can prevent AMS?

Two families of medicine have some drugs for prevention of AMS.

• Allopathy – Acetazolamide (sold by brand name diamox) is known to be effective in preventing AMS, if taken regularly (once daily with water) starting one day before the ascent and continuing till 2-3 days of reaching the maximum altitude. Avoid too much exposure to sunlight if you’re on diamox as it increases the skin’s sensitivity. However, please be advised that this is a sulfa-based drug and it may have it’s side effects including sore throat, fever, unusual bleeding or bruising, tingling or tremors in your hands or feet, pain in your side or groin, or a rash, dizziness and drowsiness. Please consult your doctor before taking on diamox. DO NOT use diamox if at all you are:
  • are on aspirin therapy,
  • have liver disease,
  • have kidney disease,
  • have heart disease,
  • have lung disease, or
  • have a hormonal disease.
• Homoeopathy – Coca 30 / Coca 6x is also known to be good in preventing AMS, with doses being 3-4 drops once daily. However, please note that homoeopathy drugs are alcohol based (as much as 95% alcohol v/v) and may result in drunken symptoms if not used to alcohol or taken excessively. Further, many western countries do not even recognize homeopathy as a medicine science.

Q. What do I do if I/my friend gets hit by AMS?

If you/your friend get hit by AMS, observe the following:

• NEVER leave someone with AMS alone.
• DO NOT ASCEND any higher. This can easily be fatal, and the symptoms will only get worse.
• IMMEDIATELY contact the NEAREST medical facility available. Quite often, Armed Forces have medical facilities and are known to help people.
• If possible, DESCEND to a lower altitude, generally by 600-1000 meters or below 2500 meters. Symptoms will disappear much more quickly.
• If descent is not possible, stay at the same altitude until the symptoms are gone and the body has acclimatised. Only then re-start ascent.
• Rest adequately.
• DRINK plenty to stay well hydrated.

Q. I’ll keep portable Oxygen cylinder with me. Won’t that be an insurance against AMS?

Oxygen, when inhaled, is known to help in AMS. However, this helps in only cases where there is loss of breath and fatigue. For acute cases, IMMEDIATE medical attention is paramount. Add to that, a portable oxygen cylinder doesn’t lasts more than 20 minutes.

Q. I have kids traveling with me. How do I know they’re hit by AMS as I suspect they would be able to express?

Kids generally adapt well to altitude than adults. However, if a kid gets hit by AMS, true that he won’t be able to identify and convey the same. As a parent, you have to keep on looking at the symptoms. Now you can’t tell whether the kid is getting a headache or not – do you? Do keep a look for any changed behaviour in kids – throwing tantrums, crying without reason, nausea, vomit, etc. These may be signs of AMS. Never EVER administer diamox to a kid on your own – consult a doctor always.

The Golden Rules (Courtsey: International Society for Mountain Medicine)

1. If you feel unwell at altitude it is altitude illness until proven otherwise. 2. Never ascend with symptoms of AMS. 3. If you are getting worse (or have HACE or HAPE), go down at once.

Disclaimer: Majority of the information has been gathered by the author’s own experience and information available on multiple websites, including that of International Society for Mountain Medicine.