Acute Mountain Sickness is something we deal with day in and day out at Indiahikes. We see several cases on our treks – from the toughest of treks to the easiest ones. But despite its frequency, we find that there is very little knowledge about it amongst the trekking fraternity. There’s not much credible information available on the internet either.
So starting with this high altitude case study, we will be documenting multiple altitude-related instances that have occurred on our treks. These are real life experiences of our trekkers. We believe that by detailing stories of evacuations, of Altitude Sickness-hit trekkers, we make the trekking community more knowledgeable. We have always maintained that a knowledgeable trekker is a safe trekker.
Here is our first High Altitude Case Study. Please note that it is a completely unbiased, factual documentation of what occurred and the remedial actions that were taken. This information has been published with the trekker’s consent.
This is a case from the Deoriatal-Chandrashila trek. The trekker’s name has been changed to protect her identity.
Facts of the High Altitude Case Study
What we knew of her fitness before the trek: Preethi had sent adequate proof of her fitness to her Ground Coordinator Prathima. It showed that she was able to jog a total of 3 km in 24 minutes.
What we observed during the trek: She told her Trek Leader that she had prepared well for the trek. However, she was among the last few trekkers to reach the campsites. On the second day of the trek, she was exhausted during the second half. Her friends expressed surprise that we took her on a trek at all. They said that she would take her car out to buy groceries from a shop that was just a few blocks away! Preethi was not fit enough for the trek.
Diamox course: She was taking half a tablet (250 mg) of Diamox twice a day for the first two days. This is the prescribed preventive course.
Bottomline of the case: Severe case of Acute Mountain Sickness on the second day of the trek. She had to be evacuated.
Details of the case, as told by our Trek Leader Venkat
Day 1: Arrival at Sari. Normal vitals
When Preethi arrived at Sari at around 6 pm, she told me she had prepared well for the trek. During the routine check-up, her vitals (Blood Pressure, Oxygen Saturation and Pulse) were normal. She had come with her friends. She was getting along with everyone.
Day 2: Short 2 km trek from Sari to Deoriatal. Mild symptoms show, fade away after Triple One Test
The next morning, before we started the trek, she had a cup of tea. She skipped breakfast. She said she doesn’t have the habit of eating breakfast. I emphasised that breakfast is important. I told her that her body needs the right nutrition for a trek. It is why we pay so much attention to the food we provide. By missing your meals, you subject your body to overdrive. On my insistence she ate just a little.
We started around 10.30 am from Sari. Even if you are a slow trekker, it would not take you more than two hours to reach Deoriatal, which is around 2.5 km away from Sari. Her pace was slow. She was among the last trekkers to reach the campsite.
On reaching the campsite, she had lunch. She complained of a headache. She had had only two litres of water the entire day. With Diamox, it is important to hydrate more than usual. Diamox is a diuretic. To put it simply, the medicine makes you pee more.
I did a Triple One Test with her. I gave her one Disprin and asked her to drink one litre of water. After an hour’s rest, she reported that her head had stopped aching.
Around early evening, when I was doing my usual rounds, I found her in a sleeveless clothing. She must have been out in the cold in the sleeveless outfit for at least 15 minutes! Your body is already struggling to acclimatise at high altitude. Exposing your skin to extreme temperature variation causes your body to go into shock. It takes a toll on your body.
I immediately asked her to layer up. Her oxygen saturation reading in the evening was normal. At 126, her resting pulse rate was towards the higher side. While her readings were normal, I still had to keep a watch on her, given she had experienced mild symptoms in the afternoon.
The next morning, she reported that she woke up twice at night to pee. She had slept soundly otherwise. That morning she had only a cup of tea and no breakfast.
Day 3: A 14 km trek from Sari to Chopta. Mild symptoms escalate to full-fledged AMS
The third day on this trek is a long one. We had to cover 14 km. We started at around 8.30 am. During the first half of the trek, Preethi was normal. She showed no symptoms. She was at the back with the last set of trekkers but her pace was steady.
After we crossed the waterfall (this is around 8 km into the trek), her pace deteriorated. She was extremely tired, dizzy and nauseous. I repeatedly checked her oxymeter readings. They were normal (98/110). I pushed her to reach the Chopta campsite.
The challenge on the Deoriatal trek is that after crossing Rohini Bugyal, you have no option but to move ahead to the next campsite. Mules are not allowed in this forest section. Evacuating a person who is not feeling well from here is quite challenging. I was hoping that she would reach the campsite safely. I stayed with her so I could constantly motivate her to reach the campsite.
My attention was on her entirely and not on the rest of the trekkers, which is not how it should be on any trek. Luckily for me, the rest of the trekkers were fit and were doing well. On an average, the batch was expected to reach Chopta by 4.30 pm. Preethi and I reached at 6.30 pm.
As soon as she reached the campsite, Preethi had tea and snacks. She retired to her tent immediately and did not come out after that. Between 7.30 pm and 8 pm, when I went to call her out for soup, she complained of dizziness. I could see that she was not doing well. I checked her oxymeter reading. It was 98/99.
While checking her vitals, I found that her pulse was not strong. Her Blood Pressure had dropped to 98/68. I was alarmed at the reading! We immediately gave her soup with extra salt. Her oxymeter reading was checked again. It had dropped to 84 in 10 minutes!
I gave her one tablet of 250 mg Diamox. The oxymeter was on her hand to continuously monitor her oxygen levels. I started her on supplemental oxygen. Her oxygen level improved while she was on supplemental oxygen. However, when oxygen was removed after an hour, her oxygen level steadily reduced to 77. She was continuously administered oxygen after that. But her responsiveness was dropping. We had to evacuate her to a lower altitude immediately.
A vehicle was arranged to take her down to Ukhimath. It has the nearest medical facility. There was a ten minute stretch where we had to walk from the campsite to the vehicle. On this stretch, we couldn’t administer oxygen to her. During this time, her oxygen level dropped rapidly. She was becoming unresponsive. We had to rush her down.
Once she was in the vehicle, we continued giving her oxygen. To my relief, her vitals improved again. The rescue team reached Ukhimath in two hours. On the way, she vomited twice. After vomiting, her vitals improved and stabilized. She was extremely weak.
After a final checkup, she was taken back to Sari. Once she had a good amount of rest, she was back on her feet.
As told by the trekker, Preethi
“I overestimated my ability to complete the trek since it was graded as an easy trek. Before the trek, I sent my ground-coordinator a proof of fitness. But they were not mine. Honestly, it was a bad idea to think I could have managed an easy trek. I am especially grateful to my Trek Leader for evacuating me in time!”
What do we take away from this case?
“Acute Mountain Sickness can hit even the most prepared trekker. But by not coming prepared and not taking care of yourself during the trek, you are putting yourself at high risk of Acute Mountain Sickness. That is not ok.
What should be an easy and enjoyable trek can easily turn into a nightmare when you are not prepared. Not just that, by putting yourself at risk you are taking up the time and energy of the Trek leader and Staff who should be equally dividing their attention to all other trekkers.
There are many things that have gone wrong here: lack of preparation, not eating right, not hydrating yourself after being on a Diamox course, exposing yourself to cold temperatures. Cold often accelerates any preceding symptoms of Altitude Sickness.
Lastly, we always associate Acute Mountain Sickness with very high altitude treks like Rupin Pass, Roopkund or Goechala. However, even on treks like Deoriatal-Chandrashila, which is considered to be a safe and easy trek, one can get Acute Mountain Sickness. Anything above the altitude of 8,000 ft is high altitude. You must take care of yourself accordingly.” – Arjun Majumdar, Founder
Feel free to drop in a comment below with your thoughts. We invite AMS-related comments and discussions. Please refrain from criticising any trekker or trek leader in the above case study. This is a factual account and is only meant for knowledge sharing purposes.
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