Altitude Sickness

Staying at high altitudes entails a lower oxygen level can result in a number of symptoms that common go by the name altitude sickness.

Sensitivity to develop altitude sickness is individual. The most important factor is how quickly one reaches a high elevation. The recommendation is not to rise more than 300 meters per day at altitudes above 3000 meters. If you are to have a reasonable chance of staying in good health and moreover having a positive experience of reaching the top of, e.g., Kilimanjaro, you need at least 7 days to climb from an elevation of 3000 metres. Faster climbing reduces your possibilities considerably.
It makes no difference whether you are in good condition or health - everyone can suffer from altitude sickness. The risk is greater if you have previously suffered from it, if you use tranquillisers or sleeping pills in connection with adapting to the altitude.
Keep in mind that flying can quickly take you to high-altitude destinations such as La Paz, Bolivia (3500 m), Addis Ababa (2400 m) or Mexico City (2300 m).

Preventing Altitude Sickness

The air is very dry at high altitudes, which is why your lungs will secrete more water, which increases your risk of dehydration. That is why it is important to drink ample amounts of water, even if you do not feel thirsty. Urine is a good indicator. It should be clear and abundant. Small amounts of dark urine is a sign that you are not drinking enough.
Stop and rest for a few days once you read a height of 2500-2800 metres and allow your body time to adjust before going any higher.
Dress properly - keep warm! Do not over-exert yourself. If you feel tired and exhausted - rest!

Stays at more than 3000 metres altitude
If you would like completely to avoid symptoms, you should not sleep at an altitude of more than 300 metres higher than you slept the night before. You can climb higher during the day, but then go down to a lower level to spend the night. The height at which you sleep is important. Climb high - sleep low!

The medicine "Diamox" can improve and speed up one’s own acclimatisation and therefore possibly can be used to prevent altitude sickness especially upon flying directly to places located above 3,000 metres. Begin the treatment the day before your arrival. Then take ½ tablet (125mg) morning and evening during the first 2-3 days at a high altitude.

Please note that Diamox should never be used to reach higher elevations if one already has symptoms! This may result in a life-threatening condition.

The most common side effects are increased urine production, dizziness, as well as tingling and numbness in the hands, arms and around the mouth. The drug is excreted via the kidneys and should therefore not be used if you have any kidney disease or in combination with certain medicines. The doctor who prescribes Diamox should have very good knowledge of the drug and how it works. As climber you may not use Diamox but instead adjust the climb rate to your health condition. The most important thing is to pay attention to your body’s signals!

Acute Mountain Sickness (AMS)
is a common occurrence and it affects approximately half of those who reach 3500 - 4000 metres. Symptoms can include headaches, dizziness, insomnia, loss of appetite, nausea and fatigue. These most often develop within the first two days and lasts seldom more than a few days. The symptoms must be taken seriously because they may develop into more serious forms.

Measures to take upon the onset of symptoms
Do not climb to higher elevations!
A headache tablet often helps. Rest! When you feel better you can climb further, but take it easy!

Serious Altitude Sickness (HAPE / HACE) 
is most common at altitudes above 4,000 meters and can lead to

• Pulmonary edema - High Altitude Pulmonary Edema (HAPE) which entails an increased amount of tissue fluid in the lungs.
• Cerebral edema - High Altitude Cerebral Edema (HACE) which entails an increased amount of tissue fluid in the brain.

In addition to the aforementioned symptoms, pulmonary edema (HAPE) also entails breathing difficulty, wheezing and heavy coughing with phlegm, white foam and possibly blood.
Other symptoms of cerebral edema (HACE) include headache, neck stiffness, vomiting, difficulty in coordination, confusion and possibly unconsciousness. In the worst case, the condition can lead to death.

Carefully watch those who are with you for symptoms that can be a sign of serious altitude sickness! A coma may occur after just a few hours after the first symptoms show.

What to do if symptoms occur
If you suspect pulmonary edema -  immediately make your way to an elevation that is at least 500 m lower. If possible, take oxygen. Consult a physician!

If you suspect a cerebral edema - immediately make your way to elevation no greater than 3000 metres, preferably under 1500 metres. 
If possible, take oxygen. Keep warm and carry the person down if possible. Give amply amounts of liquid. Consult a physician immediately!

Cold

If you will be staying at a very high altitude, this also means that you will be exposed to the cold. The combination of wind, wet clothing and hunger can quickly cause both injuries and life-threatening conditions, even if the temperature is above freezing.



Prevent

Stay dry and warm! The easiest way to do this is by wearing several layers of clothes;

• closest to your body should be a synthetic undergarment that whisks away moisture.
• then you should have a middle layer, e.g., a wool terry that maintains your body temperature and absorbs the moisture.
• the outermost layer should be wind and moisture resistant.

In order to protect your skin, it is better to wash and shave the night before. It might also be a good idea to apply a regular skin cream. Do not wash your face in the morning.
Take along some extra clothing! Don’t forget your gloves, wool hat, socks and perhaps a warm blanket.
It is important to drink fluid. Make sure you have plenty to drink.
Of course, you should avoid alcohol or drinks containing caffeine, since these are diuretics. Sugar gives you a good amount of energy.
Improve circulation by moving about.
Seek shelter in bad weather!

WIND-CHILL TABLE
Wind	Air temperature °Celsius
0 m/s	0	-5	-10	-15	-20	-25
5 m/s	-9	-15	-21	-28	-34	-40
8 m/s	-13	-20	-27	-34	-41	-48
16 m/s	-18	-26	-34	-42	-49	-57
25 m/s	-20	-28	-36	-44	-52	-60

Cold Injuries
entail the skin turning white and feeling gradually fading. In a superficial form of frostbite, the skin still feels soft, but at a deeper frostbite, the skin will turn black and die, possibly making an amputation of the body part necessary.


Superficial cold injury
Loss of sensation, as well as a stinging, burning pain. Whitened skin which can move against the underlying tissue.

Measure
Immediately protect the cold-injured area, e.g., with some kind of clothing. Do not rub but slowly warm up the area using some other warm part of the body, e.g., the armpit. Protect the area from suffering any new cold injury!


Deeper cold injury
Hard and callous skin that cannot move against the underlying tissue.
The colour is a marbled white-yellow, but it later turns blue-red and blistering occurs after a few hours.

Measure
Do not begin treating a severe frostbite before the injured persons can be kept continuously warm during and after the treatment. It is often better to allow a body part to remain frostbitten for several hours than to allow it to become warm and then let it freeze again.
Once in a protected area, remove the clothing on the frozen body part. Rinse the body part in water of approximately 40 degrees C until it feels warm. If pain occurs in connection with warming, give a painkiller. The person must then be kept warm and at rest. Seek medical help immediately!