Altitude sickness

Latest update: - Authors: Mieke Croughs, Ula Maniewski-Kelner

A person living at low altitude needs time to adjust to the low oxygen pressure at high altitude. Breathing is deeper during the first days at high altitude. This improves the oxygen supply to the organs, but also causes shortness of breath during exertion. Ascending too quickly means that there is not enough time to acclimatise and this can cause altitude sickness to develop within several hours to two days.

People differ in their susceptibility to altitude sickness and this is not related to their physical fitness. Young people are generally more susceptible to altitude sickness than older people.

Mild altitude sickness usually goes away within several days, provided you do not go to a higher altitude. However, severe altitude sickness with cerebral or pulmonary oedema (fluid accumulation in the brain or lungs) can rapidly result in death.

Symptoms of mild altitude sickness include: 

Headache, plus one or more of the following symptoms:

  • Nausea or vomiting
  • Weakness or abnormal fatigue
  • Dizziness

Symptoms of severe altitude sickness include:

  • Very severe headache, which no longer responds to painkillers.
  • Increased vomiting.
  • Disruption of balance (being unable to walk in a straight line).
  • Behavioural changes.
  • Confusion or disorientation.
  • Increased coughing.
  • Shortness of breath that does not disappear after resting.
  • Tight sensation across the chest (being unable to lie flat).

Risk areas

People who are susceptible can develop altitude sickness from 2000 metres, but severe symptoms occur primarily with overnight stays above 3000 metres.

Prevention

Health issues

If you have any health issues, first discuss with your physician whether it is wise to visit high altitude areas.

Ascending

Do not ascend too quickly: 

  • Spend at least two nights at moderate altitude first (2000 to 2500 metres). 
  • Above 3000 metres, never sleep more than 500 metres higher than the previous night or spend two nights at the same altitude if this cannot be avoided.

Adjust your behaviour

Do not use sleeping pills or alcohol during the first days at high altitude.  

Do not exert yourself strenuously during the first days at high altitude. 

Drink sufficient water to prevent dehydration. Your urine must remain light-coloured.

Acclimatisation

To facilitate acclimatisation, you can: 

  • Spend several nights at moderate altitude (2000 to 3000 metres) in the weeks before departure. 
  • Sleep in a hypobaric hypoxia tent for at least seven consecutive nights just prior to departure. 
  • Consider climbing to a higher altitude during the day, “climb high, sleep low”. Do not do this if you already have symptoms of altitude sickness.

Arterial oxygen saturation

Measuring the arterial oxygen saturation (SpO2) has only very limited value. It is much more useful to respond quickly and adequately to the first symptoms of altitude sickness.

Acetazolamide - above 3000 metres

Take acetazolamide (Diamox®) with you if you are going to be staying above 3000 metres. 

Acetozolamide facilitates acclimatisation. 

You can take it to prevent or treat altitude sickness.  

Acetazolamide as a precaution

You can take acetazolamide as a precaution if you have insufficient time to acclimatise, or if you have suffered from altitude sickness in the past at a similar altitude: 

  • Take half of a 250 mg tablet, twice a day (early in the morning and - for example - at around 16:00, so that the diuretic effect has reduced by nighttime). 
  • Start on the day before you ascend to 3000 metres or higher and continue for two days after reaching the maximum altitude. You can stop taking this medication if you descend before this time. 
  • Tingling sensations and abnormal taste sensations are common but harmless side effects. They will disappear when you stop taking the medication. As acetazolamide is a mild diuretic, you may notice a need to urinate larger volumes or more frequently.

Other tips

See also the general tips for a stay at high altitude.

In case of symptoms

In case of mild symptoms

  • Do not ascend further until the symptoms have disappeared, or descend 500 metres for the night. Descend further if the symptoms do not improve.
  • Take it easy for a few days.
  • Drink plenty of fluids, your urine must remain clear.
  • Take acetazolamide (Diamox®), one 250 mg tablet every twelve hours for three days to promote acclimatisation, particularly if you want to ascend further. You can stop taking this medication when you descend. You can start taking the medication again if you develop symptoms again, for example when ascending further.
  • Take a painkiller (1 gram paracetamol or 600 mg ibuprofen) or anti-vomiting medication (metoclopramide or domperidone). These can reduce your symptoms, but will not result in improved acclimatisation.
  • Half a tablet of acetazolamide (125 mg) at night is also effective to combat sleep disruption. 

In case of severe symptoms (refer above)

Descend immediately to 2500 metres or lower. This can save your life! Seek medical assistance as soon as possible. Call the travel assistance insurance during your trip for advice on reliable medical facilities.

If available, you can start the following whilst waiting for medical assistance:

  • Oxygen or a hyperbaric pressure bag.
  • Acetazolamide (Diamox®): one 250 mg tablet every twelve hours.
  • Dexamethasone: 8 mg as an initial dose, followed by 4 mg every six hours (or 32 mg in one dose).
  • In case of symptoms of pulmonary oedema (shortness of breath, tightness across the chest and increasing coughing): Tadalafil 20 mg in one dose or 10 mg two times per day (this medication is not registered for altitude sickness). 

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