As a pioneer in India's trekking community, Indiahikes has spent over 15 years raising awareness about the medical well-being of trekkers in the mountains.

We are putting out this detailed piece of information on High-altitude pulmonary edema with the same intention. Over several years of training, observation, and experience with tens of thousands of trekkers, we have cracked down on how to avoid it to a large extent. 

If you are a hard-core trekker reading this, then you know what HAPE is and how fatal it can get. If you are a beginner or new to trekking at high altitudes, you should read it carefully.

This piece of article is not just for trekkers. If you are planning a bike ride to Leh or flying to a high altitude, this is a very beneficial read.

So, without further ado, let’s start with:

What is High Altitude Pulmonary Edema?

Edema is the swelling caused by too much fluid trapped in a particular body tissue.

When you are at a high altitude, there’s less oxygen pressure, which means the concentration of oxygen molecules in the air is lower. As a consequence, you breathe less oxygen per breath at higher altitudes. 

So, if I ask you to take a deep breath, say, at an altitude of 2,000 ft. your lungs will consume sufficient oxygen without exerting any pressure. But at 8,000 ft, you’ll need to breathe a lot harder to consume the same amount of oxygen. At the end of the day, your lungs exert a lot of pressure for very little oxygen.

In some cases, because of high pressure on the arteries, fluid from the blood leaks into air sacs in the lungs and that’s when a trekker/traveller in high altitudes is affected with HAPE.

When HAPE occurs, a trekker is essentially drowning in his body fluids. And when the lungs are incapacitated, the rest of the body soon stops functioning. This means HAPE can get fatal very soon.

Before I dive deep into HAPE, I want you to know about its initial stages — Acute Mountain Sickness, because often, when left untreated or undetected, AMS can soon turn into HAPE (although it is important to note that HAPE can occur without preceded by AMS).

What is acute mountain sickness (AMS)? Symptoms | Treatment

Any sickness that is caused because of gaining altitude is termed acute mountain sickness, often also called altitude sickness. It starts occurring as you climb over 8,000 ft above sea level. On average, 10% of trekkers can face some sort of altitude sickness. 

It all depends on how your body is getting acclimatised at the high altitude. The quicker it adapts, the lower the chances of getting AMS.

There’s one thumb rule for gaining high altitude: Give your body the time to adapt to the altitude and the low air pressure that comes with it. You will always observe trekkers in your group who have given more time to their body to rest will acclimatise well as compared to people who gain altitude in less time.

Travelling via flights to high altitudes is the riskiest. Yes, you read this right. Say you are travelling from Delhi to Leh; Delhi's elevation is between 650 and 820 feet and Leh is at an altitude of 11,480 feet. You are gaining this altitude in a few hours. This is very little time for your lungs to adjust to such low oxygen pressure.

What are the symptoms of acute mountain sickness?

Here are some of the most common symptoms of acute mountain symptoms 

Headache: You feel an extreme headache. Please note: In most cases, the headache will happen but we shouldn’t just look for a headache to detect if it’s AMS. 

Nausea/vomiting: You feel overcome by nausea or might have a feeling of vomitting.

Fatigue: You feel extremely fatigued. You will see a significant change in your movements on the trails. 

Insomnia: When affected by AMS, you will struggle to sleep during the night

Loss of appetite: You will experience a loss of appetite. You will eat less even after a long day of trek. I recommend everyone to keep a check on their eating patterns in the mountains.

As soon as you see any of these symptoms in your body, I advise you to inform your trek leader (if you are coming with Indiahikes). Our trek leaders are trained to nip these symptoms in the bud.

After you are affected by AMS, there’s one thing that our medical trainer, Diptarka, advises everyone to do: “Go up only when symptoms go down.”

Medicinal Treatment: Right, after you feel any of the symptoms I mentioned above, put yourself on a curative course of Diamox. 

Now as we discussed acute mountain sickness, let’s climb up slowly to HAPE.

How do I detect HAPE in the mountains? How is it different from AMS? Symptoms

High Altitude Pulmonary Edema Symptoms | How do I detect HAPE? 

Multiple symptoms show both at the initial stage and at the advanced stage. Below, I will share some common high-altitude pulmonary edema (HAPE) signs and symptoms

The first symptom to look for is if you have shortness of breath at rest or if you are gasping for air even while at rest. This is one of the most common symptoms that our trek leaders at Indiahikes have observed in multiple cases.

Look for a dry cough. Please do not ignore it, at the later stage of HAPE it might get advanced and can develop into a productive wet cough.

You might also experience extreme fatigue & drowsiness.

Rattling chest sound. If you put a stethoscope or simply an ear on the chest of a HAPE-affected patient, you will hear a rattling sound.

Another symptom to detect HAPE is pale or cynatic skin colour.

At a very late stage, you might also discover pink frothy Sputum (sputum is a mixture of mucus and saliva) 

The medical trainer at Indiahikes, Diptarka, says and I quote, “I want you to note that you don't need to first have symptoms of AMS then it will turn to HAPE. HAPE can happen directly too.”

High Altitude Pulmonary Edema treatment

Our medical trainer mentions, “HAPE is the biggest killer in the mountains if you ignore symptoms.” Hence, I will help you understand the on-spot treatment of high altitude pulmonary edema.

The rule of thumb is to lose altitude as soon as possible. 

But to ease the symptoms for the trekker and buy time to descend, you must administer the right medicines: Diamox & Nifedipine.

Here’s the dosage of medicine you should take when you learn that you are affected with HAPE, assuming you do not have canned oxygen with you.

Take 500 mg of Diamox immediately (even if you have taken Diamox a few hours earlier). This means two tablets of Diamox.  

Follow it up with 20 mg of Nifedipine. In India, we mostly get 10 mg tablets of Nifedipine. So take your first 10 mg, wait for 20 minutes and then take the next 10 mg.

This will let the tablet settle in slowly. Within 30 minutes of the second 10 mg, you should be able to breathe easier.

Nifedipine reduces the pressure in your heart, lungs and blood vessels, giving it some space to breathe. If you remember, I told you that HAPE occurs because of high pressure around the lungs, when the air sacs start accumulating fluid from your blood.

With these two tablets in your system, climb down as much as possible. Start your descent & reach a safe height, at least around 8,000ft., so your lungs have to put in less work to breathe.

If you cannot reach around 8,000 ft even after six hours, repeat the dose of 500 mg Diamox and 20 mg Nifedipine and continue descending.

You’ll be tired, but it’s a matter of life and death. You need to be at a lower altitude.

Most trekkers recover upon reaching lower altitudes. You’ll recover too.

Evacuation Process at Indiahikes

If you are on a trek with Indiahikes, there are very minute chances you will be evacuated because of HAPE. We treat it at a very initial stage right after seeing the symptoms. But, there are certain cases where things are not under our control and we have to evacuate the trekker in an emergency. 

Your health is monitored three times a day. We check your vitals thrice daily, ensuring we nip any health issues in the bud, even before they show up.

Our trek leaders are handpicked outdoor experts. Our trek leaders are hand-picked and undergo rigorous training in wilderness first aid and emergency care. Our training is so intensive that only 70 per cent make it through our training. 

We always have a HAM kit handy (High Altitude Medical Kit). The HAM kit contains 17 essential medicines, including three life-saving drugs. They also carry bottled oxygen. Our trek leaders are always ready to handle medical emergencies. 

We have an evacuation kit ready for emergencies. With a stretcher, two oxygen cylinders, and an emergency shelter, our teams have tested evacuation protocols in place. They can carry out smooth evacuations even in the middle of the night. We have a complete protocol for the evacuation of a trekker. We are equipped with manpower & medical resources to bring a HAPE-affected trekker down to safety.

We cannot repeat enough that safety is in prevention. The Indian Himalayas do not allow easy evacuations. Heli rescues are unheard of on most treks. It’s extremely resource-intensive to evacuate anyone from these regions and often the weather and terrain are not on your side.  

How to prevent high-altitude pulmonary edema?

The first thing I am going to suggest here is to plan your itinerary mindfully. Give yourself rest days in between so your body gets enough time to acclimatise well.

Another, we recommend you follow a preventive course of Diamox. It helps with acclimatisation. (Read more about how Diamox helps at high altitudes.)

So for most treks that gain altitude too quickly, taking a preventive course of Diamox really helps, especially if your trek climbs above 13,000 – 14,000 ft.

In fact, even for those who suddenly go up to high altitudes, like those who drive or fly to Leh, we recommend Diamox.

| Dosage: Start with a dosage of 125 mg (half a tablet) every 12 hours 2 days prior to your trek (usually when you arrive at Delhi). Increase it to 250 mg (full tablet) every 12 hours from the day you get to the base camp and continue until you complete the trek.

| Side effects: There aren’t too many side effects of taking Diamox. You feel a numbness/tingling sensation in your hands and feet. You pee more often (which means the medicine is doing its job). Some claim that they get a bit of loosies after Diamox. Generally, a Digene takes care of this.

Keep in mind that Diamox is a sulfa-based drug. If you’re allergic to sulphides, avoid Diamox. Again I will say, consult your doctor beforehand.

While Diamox reduces the chances of AMS hitting you, it isn’t a fool-proof medicine. Even those who are on a course of Diamox can get hit by AMS.

Busting Myths About AMS

There are a lot of myths that exist about AMS. Below I am going to attach a video where the head of our Learning & Development team, Lakshmi Selvakumaran, debunks most common myths that revolve around Altitude sickness. 

How safe are you on a trek with Indiahikes?

As I mentioned we take all mandatory steps to ensure the safety of the trekkers. Multiple procedures go behind the curtains. It starts even before the trek starts

We check trekkers’ Blood pressure on the first day to ensure it is within an acceptable standard at high altitudes.

We record oximeter recordings thrice every day and ensure it never gets down to our cut-off numbers.

All the trek leaders carry with them life-saving drugs to treat AMS, HAPE, and HACE. They are trained on how to treat trekkers with these medications. 

For an emergency HAPE case, our trek leaders carry oxygen cylinders with them.

All campsites are equipped with a bigger oxygen cylinder. We are also equipped with stretchers for severe case evacuation.

The most important thing that matters is the observation. Our trek leaders observe trekkers throughout & assist them as per the situation demands.

Our trek leaders, staff, and slope managers regularly undergo extensive training to manage any medical emergency cases.

In the last two years, we have seen approximately 15 HAPE cases on Indiahikes treks. Trekkers were administered with oxygen and life saving drugs promptly. They were rescued down safely to the base camp and given required medical care in the hospital.

This detailed post helps you understand what HAPE is and what it looks like in the mountains. You can reach out to me in the comments section if you have any questions.

This detailed article on HAPE would help you understand what HAPE is and what it looks like in the mountains. If you are a beginner or new to trekking at high altitudes, you should read it carefully.

What is High-altitude Pulmonary Edema? Symptoms | Treatment | Prevention

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At Indiahikes, we have been trekking at high altitudes for over 15 years, taking over 20,000 trekkers every year. We have been lucky enough to observe a huge cross-section of trekkers, their medical well-being at high altitudes, and their physiological responses to altitude. 

Among the many issues we see is High Altitude Cerebral Edema, an advanced form of Acute Mountain Sickness. 

We have seen a few cases of High Altitude Cerebral Edema in our early years, but have cracked down on how to avoid it over several years of training and experience. 

So in this post, I am sharing what HACE is, what it looks like, its symptoms, treatment, and prevention.

What is high-altitude cerebral edema?

High-Altitude Cerebral Edema is an advanced form of Acute Mountain Sickness. When left untreated, Acute Mountain Sickness could lead to HACE.  

HACE occurs when the blood vessels in the brain dilate, resulting in the accumulation of fluids.

Edema is the swelling caused by too much fluid trapped in a particular body tissue.
The danger: HACE can turn fatal if not given immediate attention & treatment.

Symptoms of HACE: What does HACE look like?

One of the main signs of HACE is an extreme headache. It is not a normal kind of headache. It feels different. (Again, please note: some people might not feel a headache). Another symptom is confusion.

In addition to this, you will see an altered nature of behaviour. So what does HACE look like?

A person affected with HACE struggles with mind & body coordination. The phenomenon is called Ataxia. For example, in many cases, a HACE-affected patient struggles with their shoelaces, they won’t be able to walk in a straight line if you ask them to, or they might not be able to draw a circle.

They might have no idea that something is off with them. It sometimes requires another person to identify and treat the symptoms.

How to treat high-altitude cerebral edema?

If you suspect someone has HACE - immediately administer dexamethasone. It brings down the edema. If you have oxygen, administer it immediately. Once you give these two, descend.

The Rule of Thumb Says: Descend Descend Descend. 

You should start your descent as soon as you identify the symptoms of HACE. It is the most straightforward way to treat HACE. 

Certain medications help curb symptoms of HACE while you start your descent: Diamox and Dexamethasone. (This treatment is an addition to descent, and is not a standalone treatment.)

Start with a 500 mg dose of Diamox and around 8mg of Dexamethasone intravenously. This combination will reduce inflammation and stop your brain from swelling, giving you a window of a few hours to get yourself out of that altitude. 

Try to reach down to an altitude of around 8,000 ft in the next six hours. If you fail to do it, repeat the same dosage of Diamox & Dexamethasone.

Around 8000 ft. is a safe enough height. Lower the dosage only when the patient is showing some improvement.

If you notice symptoms fading away, lower your dosage of Dexamethasone to 4 mg (orally), followed by 2 mg (orally) every 6 hours. Dex needs to be weaned away and cannot be stopped immediately.

There is one very important thing, there should always be someone accompanying the HACE-affected trekker/traveller while they are climbing down. It is very risky leaving them alone.

If you are on a trek with Indiahikes, we take all the safety measures to bring you down to safety and provide you with the required professional medical attention as soon as you reach the base camp.

How to prevent high-altitude cerebral edema?

How to prevent high-altitude cerebral edema? What can you do? How can you prepare?

Our staunch belief while trekking at high altitudes is that prevention is better than cure. Here are a few preventive measures to avoid HACE: 

Acclimatise well: Plan your itinerary well. Give your body enough time to acclimatise well to the altitude.

Get on a preventive course of Diamox, especially if you’re climbing higher than 12,000 ft. Here’s a detailed article on how Diamox deals with AMS.

Work on your fitness. Indeed, a fit trekker can also get affected by HACE but physical fitness aids better acclimatisation, which helps avoid AMS and HACE. (This small clip will help you get a better understanding of how it works.) 

Hydrate yourself well and eat a good diet. 

Do not consume alcohol. Keep your diet simple & balanced.

I am attaching a detailed article on preventing altitude sickness. Give it a thorough read.
Having said that, if you are trekking with Indiahikes, you are not likely to face an advanced form of AMS / HACE, since we go out of our way with preventive measures. We aim to identify the mildest symptoms of AMS and treat it so that we are not in a state of emergency deep inside the mountains.

When is the need for evacuation?

The moment you identify symptoms of HACE, you must start evacuation. It’s already too late. For as long as you’re at the same high altitude, your brain will continue to accumulate fluids. Even if you’re on medication to treat HACE, the medicines are a mere way of buying time for you to descend.  

If you are on a trek with Indiahikes, we take evacuation calls promptly. We have manpower, medical resources, and stretchers to bring you back to a safe altitude. While we ensure our own trekkers don’t reach situations where they need such emergency evacuations, our teams have led rescue operations for multiple other organisations in the mountains. 

It’s important to identify symptoms of AMS at the earliest and treat them.

Between January 2017 and September 2024, we have seen just two cases of HACE on Indiahikes treks. This is not by chance. Our trek leaders take action promptly against AMS before it develops into HACE.

As mentioned earlier, we take all mandatory steps to ensure the safety of the trekkers. Multiple procedures go behind the curtains. It starts even before the trek starts.

For an emergency HACE case, our trek leaders carry oxygen cylinders with them.

Our belief in the mountains is simple: better safe than sorry. The mountains are always there for you to come back and trek. It cannot be at the cost of your health. 

Indiahikes Trek Leaders are casually called “doctors in the mountains” by many of our trekkers. They know high altitude issues and medications like the back of their hand. You can rest assured that you’re in safe hands with them. 

I hope this article helped you understand what High-altitude cerebral edema looks like in the mountains and how to deal with it. It is helpful for anyone going to higher altitudes & not just for trekkers. Make sure you bookmark it. 

If you have any questions, get in touch with me by dropping in your comments.

Frequently Asked Questions

1) Why does high-altitude cause cerebral edema?

HACE occurs when blood vessels in the brain dilate resulting in the accumulation of fluids. It happens beause your body is unable to acclimatise well to the higher-altitude. It starts as AMS, & if left untreated, can turn to HACE. 

Acute mountain sickness generally occurs above 8000ft. It happens because your body is unable to acclimatise to higher altitudes. Again, there’s no definite number. You can also feel the symptoms of AMS below 8000ft.

3) How to prevent high altitude cerebral edema?

To prevent high altitude cerebral edema, ensure adequate time to acclimatise to high altitude well. Most importantly, plan your itinerary well, ensure you’re fit and hydrated and be on a preventive course of Diamox if you’re climbing high quickly, especially on forced ascents like in the Himalayas.  

Among the many issues we see is High Altitude Cerebral Edema, an advanced form of Acute Mountain Sickness. Read what HACE is, what it looks like, its symptoms, treatment, and prevention.

What is High-altitude Cerebral Edema? Symptoms | Treatment | Prevention

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Trekkers often get affected by High Altitude Pulmonary Edema (HAPE), a critical case of altitude sickness that affects the lungs. The consequence of HAPE can be fatal, often within hours. This can happen on any trek, even lower altitude ones. Trekkers heading to the mountains can learn from such experiences, so that they know how to take care of themselves and others. 

Today, we’re studying one such case that occurred on the night of June 29th, 2021, on the Hampta Pass trek. Through the case study, we’ll learn what went wrong and analyse what could have been done better.

The Hampta Pass trek is notorious for altitude sickness cases. It shoots up to an altitude of 14,000 ft in less than 3 days. Picture by Aditya Bodke

It was around 9.30 pm, when the Indiahikes team saw the blinking lights. Two red beams flashed into the night sky. It came from not more than 3 km above the Chhatru campsite. 

Flanked by towering peaks and mountainsides, Chhatru is the last camp on the Hampta Pass trek. Despite being the last camp, Chhatru is still at a daunting altitude of almost 11,000 ft. 

“Initially, when we saw the lights, we thought it was trekkers navigating down the section. To get confirmation, our Slope Manager, Ravi Ranjan, reciprocated with a return blinking call. He immediately got a response from them. It was confirmed. It was a distress call,” says Aditya Bodke, Senior Trek Leader at Indiahikes. 

“We knew they weren’t Indiahikes trekkers. They could have been solo trekkers, or trekking with another organisation or local guides,” says Ravi. 

Knowing someone was in trouble, a team of 6 experienced members from Indiahikes set out towards the SOS light. 

They carried a rope (which they could convert into a stretcher), an ice axe to cut through the snow patch on the way, a high altitude medical kit and one medium-sized oxygen cylinder. They also carried 2 radio communication devices, which could relay messages to the Indiahikes campsite.  

With rare road access at the camp, they took the team SUV as far as they could, and trekked for another 2.5 km. They rushed but it took them almost 25 minutes to reach the distressed group. 

10 PM: Upon reaching them, Aditya saw a trekker wrapped in a stretcher — it was a stretcher borrowed from the Indiahikes campsite at Shea Goru (the previous campsite). Four members from another organisation stood beside the trekker. A local staff member from Indiahikes Shea Goru camp was accompanying them too. 

Doing the first thing he’s been trained to do, Aditya bent down to check if the trekker was conscious. He asked the trekker’s name. “Divyanshu,” came a quick reply from the trekker. Aditya was relieved that the trekker was conscious and in his senses. 

His next step was to check the trekkers’ oxygen level. Aditya was stunned. It was at an alarming 37% saturation. At this level of saturation, organs begin to fail. The trekker could slip into multiple organ failure soon, which would eventually lead to death. Aditya acted fast. He immediately got down to supply oxygen to the trekker. Within 20 seconds, he had the oxygen on at 8 L/min.

Noticing that the trekker was coughing mildly, it didn’t take long for Aditya to recognise it as a case of high altitude pulmonary edema (HAPE). A cough along with such low oxygen saturation at altitude is a very big sign of HAPE. Divyanshu’s teammates mentioned that he had begun coughing after crossing the mountain pass earlier in the day. Aditya didn’t need to hear anything else. 

Wasting no time, he administered 500 mg of Diamox, 20 mg of Nifedipine and 6 mg of Dexamethasone, along with continuous oxygen supply. Diamox would help him to acclimatize quickly, by expelling bicarbonates from his body. A double dose of Diamox was the need of the hour (500 mg). 

Nifedipine would reduce the fluid pressure in the lungs, which was making it difficult to breathe for the trekker. The fluid prevented a smooth transfer of oxygen into the lungs as well. This is what caused the drop in his oxygen saturation levels. 

Dexamethasone would help reduce other forms of edema (swellings). In such cases of altitude sickness, other body organs swell as well, which hampers the smooth flow of oxygen to our cells. Dexamethasone reduces the swelling. A 6 mg dose is high, but was the need of the hour.  

The trekker’s Oxygen improved to the 60’s, but did not improve beyond that. Aditya knew there was tremendous pressure on his lungs. HAPE had taken a firm grip on the trekker. There was no time to lose. 

While Aditya checked on the trekker, the rest of the Indiahikes team planned out the evacuation. They would stretcher the trekker all the way to the road head, from where they would drive to Manali (64 km away). They would take the Atal Tunnel to Manali, which would buy them a precious 4 hours, as compared to the older route through Rohtang pass.

10.20 PM: In the heart of the desert-like Lahaul, the descent was steep and rocky. Their first challenge was an icy stream they had to cross. Then came the snow. The snow traverse was a 45-degree incline directly over the Chandra river. 

With one team member ahead, one at the back, and Aditya crouching below the stretcher holding onto the oxygen cylinder, they crossed the slippery section in the light of their headlamps.

From the Chhatru campsite, an alarmed set of trekkers watched on, as a series of headlamps and flashlights lit up the mountain side on a dark night. 

10.50 PM: Within 30 minutes, the evacuation team reached the vehicle. Meanwhile, Slope Manager, Ravi had radioed our base for the larger oxygen cylinder, which is kept at all Indiahikes camps for emergency purposes. 

Once the trekker was plugged into the large-sized cylinder, the vehicle rushed towards Manali. 

Throughout the journey, Aditya monitored the trekker, making conversation, keeping him in his senses and administering oxygen. 

The trekker stopped the vehicle to urinate twice (a good sign, showing that the Diamox was working). The first pee-stop was concerning. Divyanshu’s oxygen saturation dropped from 72 to 42 in a matter of two minutes. The trekker was surviving purely on supplemental oxygen. On the second pee-stop, Aditya didn’t take a chance. He went along with him, carrying the oxygen. 

1.30 AM: It took 3 agitated hours, but the vehicle made it to Manali. “Our biggest challenge was to make the big oxygen cylinder last throughout the journey,” shares Aditya. With careful estimation, they regulated the flow so accurately that the oxygen lasted just until the trekker reached the emergency ward. 

An X-ray of the lungs showed that one lung was heavily infected (a medical confirmation of HAPE).

The hospital tested him for COVID with a Rapid Antigen test, which came negative. 

They sent samples for an RT-PCR test, the results of which came back negative the next day

At the hospital, the trekker was put on supplemental oxygen, saline drips and administered a few regular medications. However, Aditya had already given him the life saving drugs on the slope, which helped the trekker recover quickly at Manali. The lower altitude of Manali, of course, helped the most.

As we document this on July 1st, the trekker is still in the hospital, on a steady supply of oxygen. He’s doing better, with oxygen saturation in the high 90’s. He may spend a few more days in the hospital before being discharged. Divyanshu’s full recovery from this may take a few months though.

The HAPE-affected trekker, Divyanshu, was kind enough to answer some questions for a case-study, to help us assess what went wrong, and what could have been done better to avoid a near-death experience. 

8 Lessons We Can Learn from the HAPE Case Evacuation

1. Have an acclimatization-friendly itinerary 

What could have averted the whole situation is a more well-thought-out itinerary keeping altitude gain in mind. Divyanshu’s team followed an itinerary that covered the Hampta Pass trek in 4 days, as opposed to the regular 6-day itinerary. 

Day 1: Manali (6,726) to Chika (11,500 ft) 

Day 3: Balu Ka Gera to Shea Goru (12,864 ft.), via Hampta Pass (14,065 ft) 

| Analysis: “Even with the 6-day itinerary that we follow, the Hampta Pass is notorious for AMS cases. The Hampta Pass trek starts too quickly, from above 9,000 feet. These are dangerous altitudes to start a trek. What the trek requires is an acclimatisation day in between. 

Which is why, even though the distance is short, an acclimatisation day at Jwara (11,200 feet) is excellent for the trek. It saves trekkers from getting into a messy situation later on. Divyanshu’s team needed a break between Chika and Balu Ka Gera.”  

| Learning 1: Always give your body time to acclimatise when you’re going on a trek that has a forced ascent. Include acclimatization days within the itinerary, if required stay at a camp for two days.

| Learning 2: Don’t make the mistake of acclimatizing at the wrong altitude. In case of Hampta Pass, many trekkers choose to stay at Manali (6,726 ft) considering it acclimatizing. It’s not acclimatization unless you’re within a range of around 2,000 ft to your next day’s altitude. Divyanshu should have spent an extra day between the 9,000 and 11,000 feet acclimatising.

The trekker spent a day at Manali and then started the trek. He has climbed up to 14,000 ft within 3 days, which could have brought on altitude sickness a lot quicker than usual.

2. When at high altitude, suspect and treat AMS first. Don’t attribute symptoms to anything else

“The night we camped at Balu Ka Gera (Day 2), I had very disturbed sleep. I woke up every few minutes,” says Divyanshu, recalling the night before he crossed the pass. “I didn’t eat much that night either,” he recalls. 

The next day too, he didn’t eat. Neither did he have much water to drink. 

| Analysis: “All these symptoms that Divyanshu felt — a lack of appetite, sleeplessness, are symptoms of AMS,” says Sandhya UC, co-founder of Indiahikes. 

“Most trekkers wait for a headache or to vomit to recognise AMS. But lack of appetite, sleeplessness, indigestion are also symptoms that indicate that your body is struggling to cope with the altitude. It is a clear sign of altitude sickness,” she adds.

| Learning: It’s not normal to feel sleepless or a lack of appetite at high altitudes. Don’t attribute it to anything else. The golden rule at high altitude is to suspect AMS first and treat it.

3. Catch symptoms early and nip it in the bud

“On the first day from Manali to Chika, I trekked very comfortably. I was fine at the Chika campsite as well. My oxygen was well in the late 80s (a normal reading for the altitude),” says Divyanshu. 

“The second day, when I was trekking from Chika to Balu ka Gera, I could sense my pace had reduced. I was lagging behind a bit,” he recollects. “When I was at rest, my oxygen reading was around 86 in the evening, so I still felt okay.” 

“The next day, when I started my climb to the pass, I was exhausted with every ten steps. I had to stop and rest. I even handed over my backpack to our Trek Leader,” he recalls. 

It was after they crossed the pass that Divyanshu felt full-blown symptoms of HAPE, with cough and difficulty breathing. “Just walking made him wheeze,” says his friend. So much so that their Trek Leader decided that camping at Shea Goru was a bad idea and started descending to Chhatru — a crucial good decision. 

| Analysis: “Most times, HAPE doesn’t occur as suddenly as trekkers think. But after it affects you, it can reach a deadly stage within hours,” says Arjun. 

“It is clear that Divyanshu’s HAPE did not happen after he crossed the pass. His fatigue at Balu Ka Gera, his sleeplessness, his lack of appetite are all clear indicators that he already had AMS at Balu Ka Gera, which grew in intensity as they climbed to the pass, and turned into a full blown case of HAPE,” he analyses. 

Aditya Bodke adds, “It’s not easy, but at times like this, when a trekker is extremely fatigued, it’s important for the Trek Leader to take the hard call of sending the trekker back. I would have probably returned Divyanshu at Balu Ka Gera. The sooner you turn around a trekker, the better it is. You may have averted a life threatening situation. Climbing a pass with symptoms is almost like signing a death warrant.” 

| Learning: Learn about all the symptoms of AMS, HAPE and HACE well if you’re going on a high altitude trek. We have always maintained that an informed trekker is a safe trekker. 

“On another note,” adds Aditya, “don’t always rely on oximeters. They are machines after all and can go wrong. Trust your instinct, trust what your body is telling you before you trust an oximeter.”

4. Always have Life Saving Drugs (LSDs) with you on high altitude treks. Know how to administer them. 

When Aditya met Divyanshu nearly 12 hours after he showed HAPE symptoms, he learnt that no medicines had been administered to him. He immediately whipped out Life Saving Drugs from our medical kit and gave him doses of Diamox, Nifedipine and Dexamethasone.

“I think it was a turning point when you gave me those medicines,” says Divyanshu. 

| Analysis: When Divyanshu told his Trek Leader that he was feeling a bit unwell at Balu Ka Gera, if he was given 250 mg of Diamox every 6-8 hours, he might have never gotten HAPE. In fact, his AMS may have disappeared altogether,” analyses Dr Lakshmi Selvakumaran, head of Learning and Development at Indiahikes. 

“From what I’ve observed, many Trek Leaders hesitate to administer medicines. Diamox is a diuretic. Nifedipine is a bronchodilator. Dex is steroid. Most Trek Leaders worry about side effects or allergies. Frankly, if it means saving a life, it’s better to risk a small allergy than risk a trekker’s life,” she adds. 

| Learning: On a high altitude trek, always carry Life Saving Drugs (LSDs) in your personal medical kit — Diamox, Nifedipine and Dexamethasone. These are medicines that are readily available. 

Here's a real life case study that takes you through the evacuation of a HAPE-affected trekker on the Hampta Pass trek in the Himalayas.

Hape And Hace

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