Altitude sickness often known as acute mountain sickness (A.M.S.) in general may occur when people ascend too quickly normally in altitudes of over 3000 m. We ensure minimal risk by building in rest days into our trekking itineraries. Most people will feel some affect of altitude, shortness of breath and possibly a light headed, which is fairly common. Acute mountain sickness is very different and normally involves a severe headache, sickness and loss of awareness. In almost every potential case there are enough warning signs to take appropriate action.

Our expert and trained guides will advise you about any health requirements and also altitude sickness while you are trekking, so you should not worry about it, we do however recommend you get advice from your travel doctor or health advisor before you leave. The following information gives you an idea about high altitude sickness and how to minimize the affects

There are three stages of altitude sickness and symptoms.

1. Normal AMS Symptoms - Should expect but not worry.
Following are the normal altitude symptoms that you should expect but not be worried about. Every trekker will experience some or all of these, no matter how slowly they ascend.
- Periods of sleeplessness.
-Need more sleep than normal (often 10 hours or more)
-Occasional loss of appetite.
-Vivid, wild dreams especially at around 2500-3800 meters in altitude.
-Periodic breathing.
- The need to rest/catch your breath frequently while trekking, especially above 3500 meters.
-Runny nose.
-Increasing urination while moving to/at higher altitudes (a good sign)
- Dizziness.

2. Mild AMS Symptoms - NEVER GO HIGHER
Many trekkers in the high valleys of the Himalaya get mild AMS, admit or acknowledge that you are having symptoms. You need have only one of the following symptoms to be getting altitude sickness.
-Mild headache.
-Nausea
-Dizziness.
-Weakness.
-Sleeplessness.
-Dry Raspy cough.
-Fatigue/Tired.
-Loss of apatite.
-Runny nose.
-Hard to breath.

What to do if a mild symptom doesn’t go way?
-If you find mild symptoms developing while walking, stop and relax (with your head out of sun) and drink some fluids. Drink frequently.
-If mild symptoms developing while walking, stop have rest, drink some fluids and take 125-250mg Diamox. Diamox generally takes one to four hours to begin alleviating symptoms. Drink more water and consider staying close by.
-If symptoms develop in the evening, take 125-250mg Diamox and drink plenty of fluids again.
-If symptoms partially go away but are still annoying it is safe to take another 250mg Diamox 6-8 hours later.
-If mild symptoms continue getting worse try descending for a few hours which may be more beneficial than staying at the same altitude. Going higher will definitely make it worse. You’re here to enjoy trekking not to feel sick.

3. Serious AMS Symptoms - IMMEDIATE DESCENT
-Persistent, severe headache.
-Persistent vomiting.
-Ataxia (loss of co-ordination, an inability to walk in a straight line, making the sufferer look drunk)
-Losing consciousness (inability to stay awake or understand instructions)
-Mental confusion or hallucinations.
-Liquid sounds in the lungs.
-Very persistent, sometimes watery, cough.
-Difficulty breathing.
-Rapid breathing or feeling breathless at rest.
-Coughing clear fluid, pink phlegm or blood (a very bad sign).
-Severe lethargy/fatigue.
-Marked blueness of face and lips.
-High resting heartbeat (over 130 beats per minute)
-Mild symptoms rapidly getting worse.

Dangerous cases of AMS
High Altitude Cerebral Edema (HACE)
This is a build-up of fluid around the brain. It In most cases the first five symptoms on the mild and severe lists previously. Coma from HACE can lead to unconsciousness are death within 12 hours from the onset of symptoms, but normally takes 1-2 days to develop. At the first sign of ataxia begin treatment with medication, oxygen and descent. Usually 4 to 8mg of dexamethasone is given as a first does, then 4mg every six hours, Diamox every 12 hours and 2-4 liters /minute oxygen. Descent is necessary but a PAC (portable altitude chamber) bag will often be used first if available.

High Altitude Pulmonary Edema (HAPE)
This is an accumulation of fluid in the lungs and is very serious. It is responsible for all the other mild and serious symptoms and it is often accompanied by a mild fever. By far the treatment is oxygen at 4 liters a minute but using PAC (portable altitude chamber) bag treatment is a good substitute. If there is no PAC bag or oxygen then descent will be life saving. HAPE can lead to unconsciousness are death very quick.

Prevention of Acute Mountain Sickness (AMS)
- Allow sufficient time for acclimatization (After 3000 meters).
- Don’t make rapid Ascent. Don’t go too far too fast.
- No Alcohol, Sleeping pills and Smoking.
- Drink more fluid 3-4 Liters a day, clean water-boiled or treated / tea / coffee / soup / juice etc.
-Climb high and sleep low.
-Do not trek/travel alone, take guide/porter.
-Follow the advice from your guide, hotel, local, guide book.
- Descent if mild symptoms rapidly getting worse.
-Never leave or descent sick person along.
-Avoid getting cold.
-Take an easy and comfortable trekking route even if its longer.

First Aid Kit
This is the basic list to cover the more common ailments that affect trekkers. Climbing groups, expeditions and trekkers going to isolated areas will need a more comprehensive kit.

-Bandage for sprains
-Plasters/Band-aids
-Iodine or water filter (optional)
-Moleskin/Second skin - for blisters
-Antiseptic ointment for cuts
-Anti-bacterial throat lozenges (with antiseptic)
-Aspirin/Paracetamol - general painkiller
-Oral rehydration salts
-Broad-spectrum antibiotic (norfloxacin or ciprofloxin)
-Anti-diarrhea medication (antibiotic)
-Diarrhea stopper (Imodium - optional)
-Antibiotic for Guardia or similar microbe or bacteria
-Diamox 250/500mg (for altitude sickness)
-Sterile Syringe set (anti-AIDS precaution)
-Gel hand cleaner.