Prevention Is Better Than "Cure": Medications For AMS & How To Prevent It

Adventurers who travel up to high altitudes can sometimes develop AMS. People may die of altitude sickness, however, all of these deaths are preventable. If you are travelling above 2500m, please read this article as it could save your life.

What is “altitude sickness”?

There are 3 types of altitude sickness:

1. Acute Mountain Sickness (AMS)

Symptoms may cause headache, nausea and fatigue. However, if you have AMS, you should take it as a warning that you are at risk of SERIOUS FORM OF ALTITUDE SICKNESS such as HAPE & HACE. Both can be fatal.

2. HAPE

Symptoms may cause breathlessness, due to excess fluid in lungs. It is not normal to feel breathlessness when you are resting, even on the highest summit. HAPE may also cause fever and coughing up frothy spit. Usually, HAPE & HACE often occur together.

3. HACE

Symptoms causes confusion, clumsiness & stumbling due to fluid on the brain. Other symptoms may be behaviours such as laziness, violence & excessive emotion. Characteristics before death would be drowsiness & loss of consciousness.

How to treat HAPE & HACE?

Descent immediately.
Medications such as Dexamethasone & Acetazolamide should be given.
Use pressure bags & oxygen gas.

Acute Mountain Sickness (AMS):

Where does AMS usually happen?

Most people are well at altitude of up to 2500m. However, you may notice breathlessness around the altitude of 1500m. Your night vision may also be impaired. This makes symptoms above 2500m more noticeable.

What causes AMS?

Higher altitudes have lower levels of oxygen and decrease air pressure. The faster you climb to higher altitude, the more likely you will get AMS.

Symptoms of mild to moderate:

Difficulty sleeping
Dizziness / Lightheaded
Fatigue
Appetite decreasing
Nusea or vomiting
Rapid heart rate
Shortness of breath

Symptoms of mild to moderate:

Cyanosis (Blue colour to skin)
Chest tightness or congestion
Confusion
Cough
Coughing up blood
Decreased consciousness
Grey or pale complexion
Cannot walk in straight line.
Shortness of breath at rest

How to prevent AMS?

It is better to prevent rather than to treat. Here are some ways that you can prevent:

Climb up slowly. This gives time for your body to acclimatise or adjust to conditions. There is no point to rush!
Drink enough water. Keep well hydrated.
Eat enough food. Stay well nourished.
Avoid alcohol.

How to climb up safely?

Follow these recommended ascent rates of altitude to help with adjusting conditions or acclimatisation:

Spend a night at an ‘intermediate’ altitude below 3000m
Above 3000m, increase your sleeping altitude by only 300-500m
Above 3000m, take a rest day for every 1000m, for example, spend your 2nd night at the same altitude

Always try to sleep at a lower altitude, follow the hiker’s classic term – Climb high, sleep low. If symptoms occur, delay further ascent and if symptoms become worse, start descending. However, take special care if you have had AMS before.

Are there medications to prevent AMS?

Yes, there is. Please understand that the medicines are consume to PREVENT, but not to CURE. There are 2 medicines that is used to prevent AMS.

1. Acetazolamide (Diamox)

This is the most tried and tested drug for altitude sickness prevention. However, Diamox does not mask the symptoms but actually treats the problem such as reducing the severity of the symptoms. Diamox helps you to breathe better and speeds up your rate of adjusting to conditions only (during acclimatisation). This medicine can make you urine more often so it is important for you to drink plenty of fluids and avoid alcohol when taking this medicine

Side Effects: Tingling of the fingers, toes & face. Pins & needles. Excessive urination.

WARNING! DO NOT TAKE DIAMOX IF:

1. you are allergic to:

- DIAMOX or any of the ingredients listed at the end of this leaflet - medicines called sulphonamides, which are a group of antibiotics used to treat bacterial infections, or sulphonamide related medicines Some of the symptoms of an allergic reaction to DIAMOX or sulphonamides may include fever, rash and crystals in the urine.

2. you have chronic noncongestive angle closure glaucoma.

3. you have any of the following conditions: - marked liver or kidney disease If you have chronic liver disease and you take DIAMOX you are at risk of brain and nervous system damage. - problems with your adrenal glands - unusual amounts of salt in the body - low levels of sodium, potassium or bicarbonate in your blood

4. you are pregnant. DIAMOX should not be used in pregnancy, especially during the first trimester.

2. Dexamethasone

Dexamethasone is a type of steroid used to treat brain tissue swelling due to fluid leakage or having trouble breathing. Immediate descend of 600m can be lifesaving. Obvious improvement of this medicine usually occurs in about 6 hours. This medicine “buys time” especially at night when it may be a problem to descend. Dexamethasone is a powerful drug and should be used with caution and only on the advice of a physician & should only be used to AID acclimatisation by sufficiently qualified persons or those with necessary experience of its use.

Side Effects: Euphoria (in some people), trouble sleeping & increase blood sugar level in deabetics.

WARNING! DO NOT TAKE DEXAMETHASONE IF:

1. you are pregnant, trying for a baby or breast-feeding.

2. you have high blood pressure.

3. you have had a heart attack or have any other heart problems.

4. you have liver or kidney problems.

5. you (or anyone in your family) have diabetes mellitus or glaucoma (increased eye pressure).

6. you have osteoporosis (weakened bones).

7. you have an underactive thyroid.

8. you have ever had a mental health problem, such as depression or psychosis.

9. you have epilepsy.

10. you have had a stomach ulcer or an inflammatory bowel disorder.

11. you have recently had, or are about to have, any vaccinations.If you have any kind of infection, or if you have ever had tuberculosis (TB).If you (or anyone you are in close contact with) have recently had chickenpox, measles or shingles.

12. you have ever had a blood clot in an artery or vein.

13. you have myasthenia gravis (this is a condition causing muscle weakness).

14. you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.

15. you have ever had an allergic reaction to a medicine, or if you have ever developed muscle pain after taking a steroid medicine.

PREVENTION IS BETTER THAN CURE