Dealing with Altitude Sickness in the Himalayas

Understanding Altitude Sickness

Altitude sickness (AMS - Acute Mountain Sickness) happens when your body cannot get enough oxygen at high altitude.

These treks often reach 3,500-5,400m (11,500-17,700 ft), where AMS risk is significant.

Types of Altitude Illness

1. Acute Mountain Sickness (AMS)

Mild to moderate symptoms: Headache, fatigue, dizziness, loss of appetite, nausea, disturbed sleep.

2. High Altitude Cerebral Edema (HACE) - Life-threatening

Severe headache, confusion, loss of coordination, staggering walk, hallucinations.

3. High Altitude Pulmonary Edema (HAPE) - Life-threatening

Persistent cough, breathlessness at rest, frothy or pink sputum, and extreme fatigue.

Risk Zones in These Trekking Areas

• Annapurna Circuit: Thorong La Pass (5,416m) - major risk zone.

• Mustang & Muktinath: Lo Manthang (3,800m), Muktinath (3,800m) - moderate risk, risk rises if arriving too fast.

• Manang: Above 3,500m - acclimatization days crucial.

• Dolpo Region: Several passes above 5,000m - very high risk, remote with limited rescue options.

Prevention Strategies

(The golden rule: Climb high, sleep low)

Acclimatization Rules

• Above 3,000m: Gain altitude slowly - not more than 300-500m sleeping elevation per night.

• Take a rest/acclimatization day every 1,000m.

• If available, do a short hike to a higher point in the day, then return to sleep lower.

Hydration & Nutrition

• Drink 3-4 liters of water daily (avoid excessive alcohol/caffeine).

• Eat high-carb meals for energy.

• Avoid heavy alcohol for the first 3-4 days at altitude.

Pacing

• Walk slowly - rest step technique on steep climbs.

• Avoid the competitive pace with faster trekkers.

Acclimatization Days

Manang (3,540m) on Annapurna Circuit is the classic acclimatization stop, including a side hike (e.g., Ice Lake, Praken Gompa) before going higher.

Recognizing Symptoms Early

Immediate Actions if Symptoms Appear

1. Mild symptoms - Stop ascending, rest at the same altitude until fully recovered.

2. If symptoms worsen, Descend 500-1,000m as soon as possible.

3. For severe symptoms-

   1. Immediate descent is non-negotiable.

   2. Administer oxygen if available.

   3. Arrange emergency evacuation (helicopter in Nepal via trekking insurance).

Role of Medication

We will not provide direct dosages here.

• Certain medications can help with prevention and treatment, but must only be used if prescribed by a doctor before your trek.

• Before your trip, consult a travel or altitude medicine specialist to discuss your trekking plan and whether medication is recommended for you.

Oxygen & Pressure Bags

• Oxygen cylinders: Available in some tea houses in Manang, Muktinath, and Jomsom, expensive and with limited supply.

• Portable hyperbaric chamber (Gamow bag): Carried by some expeditions and remote medical camps, can stabilize a patient until descent.

Communication & Evacuation

• Carry a Nepali SIM card (Ncell/Nepal Telecom) for emergency calls.

• In remote Dolpo, carry a satellite communicator (Garmin inReach, SPOT) - cell coverage is nonexistent.

• Ensure you have trekking insurance that covers helicopter evacuation above 5,000m.

Special Notes for These Trekking Areas

• Annapurna Circuit: Never skip acclimatization in Manang; Thorong La is the highest risk point.

• Mustang: Risk lower but still possible; travelers from Pokhara/Jomsom can gain altitude too quickly.

• Muktinath: Pilgrims arriving by road/flight can be at sudden risk - recommend one night acclimatization in Jomsom or Kagbeni.

• Manang: Stay at least 2 nights before crossing the higher passes.

• Dolpo: Always carry your own AMS response kit - rescue may take days.

Final Safety Checklist

• Build rest days into your itinerary.

• Learn to recognize early AMS signs.

• Never sleep higher if symptoms persist.

• Descent is the most effective treatment.

• Get insurance covering high-altitude rescue.

• Have an emergency communication plan.