Adventures in India

There are inherent risks in traveling at high altitude. The information provided here is designed for educational use o­nly and is not a substitute for specific training or experience. Princeton University and the author assume no liability for any individual’s use of or reliance upon any material contained or referenced herein. This paper is prepared to provide basic information about altitude illnesses for the lay person. Medical research o­n high altitude illnesses is always expanding our knowledge of the causes and treatment. When going to altitude it is your responsibility to learn the latest information. The material contained in this article may not be the most current.

Prevention of altitude illnesses falls into two categories, proper acclimatization and preventive medications.Below are a few basic guidelines for proper acclimatization.

• If possible, don’t fly or drive to high altitude. Start below 10,000 feet (3,048 meters) and walk up.
• If you do fly or drive, do not over-exert yourself or move higher for the first 24 hours.
• If you go above 10,000 feet (3,048 meters), o­nly increase your altitude by 1,000 feet (305 meters) per day and for every 3,000 feet (915 meters) of elevation gained, take a rest day.
• “Climb High and sleep low.” This is the maxim used by climbers. You can climb more than 1,000 feet (305 meters) in a day as long as you come back down and sleep at a lower altitude.
• If you begin to show symptoms of moderate altitude illness, don’t go higher until symptoms decrease (“Don’t go up until symptoms go down”).
• If symptoms increase, go down, down, down!
• Keep in mind that different people will acclimatize at different rates. Make sure all of your party is properly
• acclimatized before going higher.
• Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts per day). Urine output should be copious and clear.
• Take it easy; don’t over-exert yourself when you first get up to altitude. Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
• Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.
• Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.
• The acclimatization process is inhibited by dehydration, over-exertion, and alcohol and other depressant drugs.

Preventive Medications:

Diamox (Acetazolamide) allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg. twice a day (morning and night). (The standard dose was 250 mg., but their research showed no difference for most people with the lower dose, although some individuals may need 250 mg.) Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. These side effects may be reduced with the 125 mg. dose. Side effects subside when the drug is stopped. Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies. Frank Hubbell of SOLO recommends a trial course of the drug before going to a remote location where a severe allergic reaction could prove difficult to treat.

Dexamethasone (a steroid) is a prescription drug that decreases brain and other swelling reversing the effects of AMS. Dosage is typically 4 mg twice a day for a few days starting with the ascent. This prevents most symptoms of altitude illness. It should be used with caution and o­nly o­n the advice of a physician because of possible serious side effects. It may be combined with Diamox. No other medications have been proven valuable for preventing AMS.

Note: Note: Copyright © 1995 Rick Curtis, Outdoor Action Program, Princeton University.