How To Treat Acute Mountain Sickness (AMS), High Altitude Pulmonary Edema (HAPE), High Altitude Cerebral Edema (HACE)

Today’s article is an important one – it’s about how to treat altitude sickness such as AMS, HAPE & HACE.

Before I get into medications and technicalities, I want to share a golden rule with you. And it is not about descending, which most manuals will talk about. It is something you must always remember.

When it comes to altitude sickness, the golden rule is to stop it in its initial stages. The later it gets, the more dangerous it gets, and it could even turn fatal.

To stop it in its initial stages, recognising the symptoms is key.

In another post, I told you how to recognise the symptoms of altitude sickness. If you missed it, read it here.

With that in mind, let’s get on to treating altitude sickness.

First things first.

You need to carry three absolutely essential Life-Saving Drugs (LSDs) with you on a high-altitude trek. It does not matter if you are trekking alone or with a group.

These are Diamox, Dexamethasone and Nifedipine. In India, you can buy them off the counter in most pharmacies even though these are prescription drugs.

Diamox is a diuretic. To put it simply, it helps speed up acclimatisation.

Dexamethasone (Dex) is a steroid. It prevents your body from releasing substances that cause inflammation. That’s how it helps temporarily treat edema.

Nifedipine is a drug that reduces your blood pressure. You use it only if you have HAPE.

Now let’s see how we can treat altitude sickness i.e. AMS, HAPE and HACE with these LSDs.

Let’s start with the easier one, Acute Mountain Sickness (AMS)

AMS is the most common form of altitude sickness we see. It starts off with relatively mild symptoms. But if left untreated, it gets severe and could form into either HAPE or HACE. 

You’ve got to absolutely treat it when it’s mild (no rocket science there).

I’ll let you learn about AMS symptoms directly from someone who was hit by AMS. 

It’s the story of my old colleague, Suhas, who was recently on the Devkyara exploration in Uttarakhand.  

He says, “We were at the first campsite, at around 8,500 ft. We had had a long day of trekking, mostly ascending and I was exhausted. Although I didn’t feel like eating much, I took two small rotis (which I couldn’t finish). After eating just one and a half roti and drinking some water, I went to sleep.

In my tent, I kept feeling very queasy and at around 10:30 pm, I finally stepped out of the tent and threw up. The uneasy feeling stayed with me all night and prevented me from sleeping. As I tossed and turned in my sleeping bag, I kept debating whether I should wake someone up, but I didn’t. 

The next morning, after breakfast, I was again not feeling comfortable. I threw up everything I’d eaten. On the trek, when there was an ascent, I started to feel very tired. I was unable to carry my backpack. It was taking me almost double the time that I would normally take to cover the distance. Throughout all this, I never told anyone about my symptoms. Finally, it was Arjun and Sandhya who noticed that all wasn’t well with me.”

What Suhas has said here are classic symptoms of AMS – uneasiness, vomiting, lack of sleep, fatigue, and lack of appetite. Notice how he never told anybody about his symptoms? This is also typical behaviour of someone who has been hit by AMS. Notice, also the rather low altitude.

Do you know what the funny thing is?

He didn’t have a headache even for a minute! Most trekkers actually wait for a headache to confirm if it’s AMS. That’s not wise.

So here’s what you need to keep in mind. Drill it in. AMS can climb onto you in different ways. Not all the symptoms may show up (especially headache), but some of them will. Remember, the best way to treat altitude sickness is to recognize it early and take all steps to prevent it from getting worse.

Look out for feeling generally uneasy. Especially a bad feeling in the stomach and a pukey feeling. Look out when your pace reduces (and you’ll know it yourself, but don’t fool yourself into thinking you’ll get over it).

Do also keep an eye out for headaches as they are an indicator of possible AMS.

You need an exceptionally sharp eye to spot these things in others. But if you have AMS yourself, you should be able to identify it. You just need to be aware of the symptoms.

Another way to tell if it’s AMS is if you have a pulse oximeter handy. You’ll find that oxygen levels have dropped. Anything below 85 is usually a low reading. And 83 is not 85. If it is below 85, take steps.

Now, here’s the important thing. Don’t trust the pulse oximeter too much. It is, at the end of the day, just a device. Trust your symptoms more. That’s the only thing we go by in the mountains.

When you have learnt that you have AMS.

When you have learnt that you have AMS

The first thing you must do if you have AMS is start a curative course of Diamox.  

(I’m using “curative” here as this course is different from a “preventive” Diamox course. I’ll tell you more about that in my next post).

Take 250 mg of Diamox (one tablet). Drink 500 ml of water and rest for an hour. Even if you are mid-trail, try and rest for an hour. Resting is imperative because any kind of exertion depletes your body’s oxygen content.

After this medication, this is what could happen. In an hour’s time, your symptoms may reduce, but may not completely disappear.

So move to your next camp. Take the rest immediately. After 4 hours (of the first tablet) take another dose of Diamox (250 mg). Keep yourself well hydrated. Avoid exerting yourself. Don’t go on sightseeing walks.

In all probability, it is going to be evening by the time you have taken the second dose.

The next few hours are critical. You want to take all the necessary steps before night-fall. If you feel better within two hours of your second Diamox dose, then your body has started to acclimatise. But continue to be on a course of Diamox (250 mg), every 12 hours for the rest of your trek, starting that night. If you are not feeling better, do not panic. We go to the next level of medication. 

At around 9.00 pm take another dose of Diamox (again, 250 mg). Also, take 1 mg of Dexamethasone (we’ll call it Dex from now on). Dex is going to help reduce inflammation in your body that causes these altitude sicknesses. The Diamox and Dex combination will help you sleep better.

The next morning, you have to make a decision.

If you have slept well and feel better with none of the uneasiness, your body has acclimatised.

Continue your trek but be on a course of Diamox (250 mg) every 12 hours starting that morning. End the course only after you complete the trek.

Remember, it is important to be honest with yourself at this stage. Continuing on the trek while feeling uneasy can lead to further complications. Additionally, don’t worry about your money, given the circumstances you will be allowed to come back for the same trek for free. (Refer to our trekking policy).  

If you still have a lingering sense of uneasiness, then it is time to accept that your body is not acclimatising despite medication.

Start your descent. Continue to descend until you have got yourself to an altitude of around 8,000 feet. This may take time. But the good thing is that with every 1000 feet that you descend, you’ll feel better.

A word of caution. Just because you start feeling better, do not stop your descent. An abrupt stop can make your AMS come back.  

Now, that’s how you treat altitude sickness such as AMS. It really isn’t difficult. Monitoring symptoms is everything!

Let’s get on to HAPE now.

2. How to treat High Altitude Pulmonary Edema (HAPE)?

The symptoms of HAPE are very distinct, but you could miss them if you’re not paying attention.

There are two things you should be able to catch – cough and breathlessness.

If you have HAPE, you’ll cough a very dry cough every now and then.

Next, notice how you walk around the campsite. If your movements are laborious or your breathing is heavy, it is a big warning shoutout. You may even notice yourself breathing heavily while sitting. Anything will tire you. There is always a feeling of fatigue.   

These are the initial stages of HAPE. It is during these stages that you must recognise HAPE and start treatment immediately.

I hate to say it but if there is any symptom beyond this – like the rattling sound from the chest, or blue-ing nails and lips, then HAPE has advanced. And HAPE escalates very quickly.

To treat altitude sickness such as HAPE, you need Diamox and Nifedipine. (I’m writing this assuming that you may not have canned oxygen with you as our Trek Leaders do. Supplementary oxygen can also work wonders while evacuating a HAPE patient.)

When you have identified HAPE, take 500 mg of Diamox immediately (even if you have taken Diamox a few hours earlier). We are talking about two tablets.  

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 and blood vessels. 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.

Nifedipine eases out the pressure around your lungs, giving it some space to breathe.

With these two tablets in your system, start descending. You should try to lose as much altitude as possible over the next three hours.

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.

Again, it’s very important to remember that the best way to treat altitude sickness is by keeping an eye out for your symptoms and taking the necessary steps such as descending to a lower altitude. You do not want HAPE to escalate.

Next, let’s discuss HACE.

3. How to treat High Altitude Cerebral Edema (HACE)?

The key to the treatment of any altitude sickness is early detection. The earlier you catch the symptoms the faster you can take steps to ensure the altitude sickness is controlled.

It isn’t hard to detect HACE. With HACE, almost always, you’ll have a bad headache (because HACE is a swelling of the brain). You’ll find it hard to do daily activities such as just zipping up your tent, or putting on a jacket. In addition, you may appear dazed and confused to others, saying irrational things. You might keep forgetting things too.

You may also continue to feel pukish with a general uneasiness.

All these are symptoms of HACE. It means your brain is swelling with an accumulation of fluid.

Like HAPE, there’s no treatment to cure HACE. What you can do is prevent its acceleration and keep it from turning fatal. The only way out of HACE is to descend and lose as much altitude as soon as possible.

To help you do that, start with a 500 mg dose of Diamox and around 4mg of Dex. This combination will stop your brain from swelling, giving you a window of a few hours to get yourself out of that altitude.

Start your descent immediately. Try to get to an altitude of around 8,000 feet as soon as you can.  

If you still cannot reach lower altitudes after six hours, repeat the same dose and continue your descent.

Don’t stop until you have reached around 8,000 ft. Once you have reached a lower altitude, lower your dosage of Dex to 2 mg, followed by 1 mg every 6 hours. Dex needs to be weaned away and cannot be stopped immediately.

What you should know about altitude sickness

Altitude sickness is not something that is too difficult to understand or treat. The main problem that plagues the trekking community is the lack of knowledge about it.

Through this post, I hope you have learnt what to watch out for and how to tackle any symptoms.

Of course, it’s not easy to figure things out overnight. It requires years of experience to actually put a finger on the issue and treat it. But with a basic understanding of the science behind it, there’s a lot you can do to make someone with AMS feel better and save him.

Also, know that communication is the key to treating AMS!

If you’re trekking with Indiahikes, always keep your Trek Leader informed of your symptoms. You’ll, of course, have your own Health Card to keep track of your vitals and your symptoms.

The most important thing when it comes to treating altitude sickness is the need, to be honest, and vocal about your symptoms. Failing to mention your concerns or potential symptoms to trek leaders is a massive disservice to yourself. Our trek leaders are well-equipped to treat altitude sickness and the earlier they know the faster they can act.

If you’re trekking solo or with a group of friends, then it’s imperative that all of you have this knowledge of treating altitude sickness. Share this article with them. 

That’s all.

After reading this, head over to the most helpful post of them all, on how to prevent Acute Mountain Sickness altogether!

Let me know if you have any questions.