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Backpacker Magazine – October 2011

The Manual: Stay Healthy at Altitude

Play it safe against altitude sickness.

by: Randy Stockbridge

Illustration by Supercorn
Illustration by Supercorn



Treatment: OTC
Take ibuprofen for headaches and ginger extract or capsules for nausea. Altitude accelerates dehydration, which compounds AMS symptoms; avoid alcohol, reduce caffeine intake, and drink enough water so your urine is pale. Eating carbohydrates may also help combat fatigue. If symptoms don’t improve after two days, descend. If you have severe trouble breathing or are disoriented, descend immediately and seek medical attention.

Treatment: Prescription

>> Acetazolamide
This diuretic—sold under the brand name Diamox—is a go-to drug for AMS prevention and treatment. Diamox causes your kidneys to excrete bicarbonate, which slightly acidifies the blood, causing deeper breathing and increased blood oxygen levels. For prevention, take it a day or two before you hit the trail. If you take it when symptoms strike, expect to wait 24 hours or more before they subside. Acetazolamide does not treat HACE or HAPE, so if AMS symptoms persist or worsen, descend to a lower elevation. Side effects include numbness of the extremities and sun sensitivity. Also, carbonated drinks taste bitter, metallic, or sharp.

>> Dexamethasone
An alternative for hikers who can’t tolerate Diamox, dexamethasone treats symptoms of AMS, HAPE, and HACE. This powerful steroid reduces swelling and fluid buildup, but does not speed acclimatization. It’s also an immunosuppressant, so it’s not safe for long-term use.

>> Viagra and Cialis
Don’t believe the rumors. Both drugs decrease blood pressure in the lungs, but, says Luks, “These medications have no proven role in the prevention or treatment of AMS or HACE.”

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Maxine henry
Mar 10, 2012

I seldom get altitude sickness when I'm climbing in to a location but have now had it several times when flying in to high altitudes - e.g. La Paz and Quito. I go a day early and plan on being sick for 24 hrs. Nasty headache, vomiting and extreme fatigue. There is no "down" to go to. I drink lots of water, take ibuprofen and electrolytes. Any thoughts or suggestions??

Mar 09, 2012

Dont be afraid to use Diamox or Viagra. It helps a lot if you start taking it 24 hours before you start & got me over 19,000.

Erin F
Jan 02, 2012

I LIVE at 5K and if I attempt to sleep above 10K feet on my first night - I get nailed by mountain sickness.

While I agree that one should not be frightened of ascending, one should go cautiously the first time and learn one's own personal needs and possible restrictions.

Descending almost always makes the person feel better. When I first discovered I was susceptible to AMS, it was my first backpacking overnight. I didn't feel well at camp and after an hrs rest (tried to eat, drink electrolytes) I finally decided to break camp, descend 500ft (or maybe 750, def less than 1k), vomiting once along the way, and sleep at a lower elevation. I felt much better when I descended.

Acclimating to 5K or even 10K feet helps, but every person is DIFFERENT. My boyfriend has zero issues with altitude, while I can't sleep the first night above 10K.

I thank the heavens I was with a partner the day I learned my susceptability. Since then, I have managed to backpack up to above 11K, but I'm no fool. I know my restrictions, always try to sleep below 10K the first night (which sometimes requires an extra night) to help myself adjust.

Each person is different, but you won't know your personal restrictions until you try!

Eric Nelson
Nov 07, 2011

My father-in-law and two of my kids (age 12 and 9) and I did a day hike from about 9000 to 12000 feet in CO. My daughter, the 9 year old, had a bad headache at the top. We had a quick lunch, I gave her a couple Ibuprofen (yeah, I know it says it's for 12 an over) and she was fine about half way down. I did not monitor her water intake carefully, but she certianly could have been a little low. We had been at or above 5000 feet for nearly a week so I figured the kids and I were acclimatized. We are from Michigan. We hiked nine miles round trip. They were great to have along, and Grandpa told us all about jackstrawing of the lodgepoles and helped us identify many other western apline trees. Don't be afraid to take your youngin's up high. They'll love it. AND DRINK LOTS OF WATER!!

Nov 05, 2011

I have only had Altitude sickness twice in my backpacking/hiking career of about 40 years. I have gotten tired as heck because of altitude, but once acclimated I will do great. When you can avoid it it's great, but when it happens, whoa!!! Both times I got it, I aborted and went to lower altitude then was able to recover. The first time it was just headaches, the last time this past year it was headache, severe nausea and some vomiting, but I returned to the trailhead about 1200 ft below and recovered 100%. Scared my friends but it turned out good. It does bring out all had our "altitude sickness" stories.

I do know another father/son story exactly like what was described by Jason W. What do you do when this occurs after some days on the trail? lower altitude and rest!

Nov 05, 2011

AMS hits me going from sea level to 5000 ft. Taking gingko biloba - 250 mg doses 3 times daily - starting a few days before and continuing into the trip reduces symptoms and duration. Limited studies have been done and it doesn't work for everyone. Acclimation is still the best.

Nov 04, 2011

Ginger is also an excellent anti-inflamatory

Nov 04, 2011

Nov 04, 2011

Another important detail left out of this article is that just because a few trips may be symptom free, it does not mean that future ones will be as well. Experienced mountaineers and Sherpas have gotten in trouble and/or died of altitude related causes despite having summited many mountains, or in the case of Sherpas, lived at altitude all their lives.

Nov 04, 2011

I would like to see some of the sources of information used for this article. The article seems to suggest that aerobic exercise will help minimize risks and suggests increasing iron intake. As far as all my research has shown, there is no evidence linking physical fitness and decreased risk for AMS. In fact, explicitly states there is no link between physical fitness and susceptibility to altitude sickness. The only way to decrease risk are acclimatization and taking it slow on the way up. In fact, in his book on the subject, Bezruchka suggests that those less in shape may be less inclined to experience symptoms as they tend to be slower, taking longer to gain altitude.

Furthermore, the article suggests eating red meat. Studies have shown that eating red meat may be associated with elevated blood pressure. Given that blood pressure medication is used to treat altitude sickness, I sincerely question the benefit at placing one's self at higher risk for elevated blood pressure while going to altitude. suggests taking steps to lower blood pressure while going to altitude (i.e. avoiding alcohol and excessive salt intake).

I hope that the writer of this magazine took time to get all the facts straight before providing potentially dangerous information to readers. I also wish that the editors would be a bit more prudent about fact checking.

Jason W.
Nov 04, 2011

My 12 year old showed signs of AMS (severe headache and vomiting) on the way to Kings Peak at our 10k base camp. Trouble was the trailhead was 8 miles away (in the dark) and only dropped 500' or so. Felt kind of stuck. He survived the night in misery, and insisted on summiting the next day despite my grave reservations. This stuff is real.


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