Ultimate Altitude Sickness Prevention Cheatsheet

Introduction to Altitude Sickness

Altitude sickness, also known as Acute Mountain Sickness (AMS), occurs when you cannot get enough oxygen from the air at high elevations. The condition happens most commonly above 8,000 feet (2,400 meters) but can affect some individuals at lower elevations. At high altitudes, air pressure drops and less oxygen is available, causing your body to work harder to supply oxygen to your brain, muscles, and organs. Understanding altitude sickness prevention is crucial for anyone planning trips to mountainous regions, high-altitude cities, or engaging in activities like hiking, skiing, or climbing at elevation.

Core Concepts of Altitude Sickness

Types of Altitude Illness

Risk Factors

• Rapid ascent to high altitude
• Previous history of altitude sickness
• Living at low elevation
• Physical exertion at high altitude
• Certain pre-existing medical conditions
• Age (not a strong predictor, though children may be more susceptible)
• Genetic predisposition
• Dehydration
• Alcohol consumption
• Use of sleeping pills

Preventive Strategies Before Your Trip

Pre-Travel Medical Considerations

• Medical Consultation: Schedule a check-up 4-6 weeks before high-altitude travel
• Pre-Existing Conditions: Get specific advice if you have heart, lung, or blood disorders
• Review Medications: Discuss current medications and potential interactions with altitude medications
• Altitude Preparation: Consider pre-acclimatization training if available in your area
• Travel Insurance: Ensure coverage includes high-altitude evacuation and treatment

Physical Preparation (4-6 Weeks Before)

• Cardiovascular Training: Improve aerobic fitness with regular cardio exercise
• Strength Training: Focus on leg and core strength for hiking/climbing activities
• Endurance Building: Gradually increase workout duration to build stamina
• Respiratory Exercises: Practice deep breathing techniques to improve lung capacity
• Hydration Habits: Establish good hydration habits before your trip

Equipment and Supplies Checklist

• Medications:

  • Prescription altitude medications (acetazolamide/Diamox)
  • Pain relievers for headaches (ibuprofen/acetaminophen)
  • Anti-nausea medication
  • Personal prescriptions in sufficient quantity

• Monitoring Equipment:

  • Portable pulse oximeter
  • Altitude tracking device or app
  • Thermometer

• Hydration and Nutrition:

  • Reusable water bottles or hydration system
  • Electrolyte replacement products
  • High-carbohydrate snacks
  • Ginger candies or tea (for nausea)

• Environmental Protection:

  • High SPF sunscreen
  • UV-protective sunglasses
  • Lip balm with SPF
  • Moisture-wicking clothing layers

Acclimatization Strategies

Gradual Ascent Protocol

Acclimatization Techniques

• “Climb High, Sleep Low”: Ascend to higher altitudes during the day, return to lower elevation for sleeping
• Rest Days: Schedule full rest days during ascent to allow body adaptation
• Graded Exercise: Start with light activity, gradually increasing intensity over days
• Breathing Techniques: Practice deep, slow breathing to improve oxygen uptake
• Staged Approach: Consider spending 1-2 nights at intermediate altitudes when possible
• Flexible Itinerary: Allow for extra acclimatization days if symptoms develop

Daily Management at Altitude

Hydration Protocol

• Minimum Intake: 3-4 liters of water daily (more during exertion)
• Hydration Schedule: Drink 1 cup (250ml) every hour while awake
• Urine Check: Maintain light-colored urine as indicator of proper hydration
• Electrolyte Balance: Replace salts lost through sweating with electrolyte solutions
• Morning Hydration: Drink 500ml of water upon waking
• Avoid Diuretics: Limit caffeine and alcohol, which increase fluid loss

Nutrition Guidelines

• Caloric Needs: Increase calorie intake by 200-300 calories per day above 10,000 ft (3,000m)
• Carbohydrate Focus: Maintain diet of 70% carbohydrates at high altitude
• Meal Timing: Eat smaller, more frequent meals to ease digestion
• Iron-Rich Foods: Include foods high in iron to help red blood cell production
• Protein Intake: Moderate protein consumption (excessive amounts may worsen AMS)
• Simple Sugars: Consume easily digestible carbohydrates during activity
• Salt Intake: Slightly increase salt consumption to help water retention

Sleep Optimization

• Elevation Considerations: If possible, sleep at lower elevation than daily maximum
• Position: Sleep with upper body slightly elevated if experiencing breathing difficulties
• Warmth: Maintain proper body temperature with appropriate sleeping gear
• Pre-Sleep Routine: Avoid heavy exercise within 2 hours of bedtime
• Breathing Awareness: Consider using breathing techniques to improve nocturnal oxygenation
• Avoid Sedatives: Don’t use alcohol or sleeping pills, which can depress breathing
• Portable Oxygen: Consider supplemental oxygen for sleeping at very high altitudes (above 15,000 ft/4,500m)

Activity Management

• Pacing: Adopt a “slow and steady” approach to all physical activities
• Rest Steps: Use rest-step technique for steep ascents (momentary pause between steps)
• Breathing Rhythm: Coordinate breathing with movement (e.g., inhale-step, exhale-step)
• Heart Rate Monitoring: Keep exertion level moderate (stay below 70% of maximum heart rate)
• Rest Frequency: Take brief rests (1-2 minutes) every 30-45 minutes of activity
• Load Management: Minimize pack weight to reduce exertion
• Energy Conservation: Use efficient movement techniques to conserve energy

Medication and Supplementation

Prescription Medications

Over-the-Counter Options

• Ibuprofen: 400-600mg every 6-8 hours for headache prevention and treatment
• Acetaminophen/Paracetamol: 650-1000mg every 6 hours for headache relief
• Ginger Products: Tea, candies, or capsules for nausea management
• Antacids: For altitude-related digestive discomfort

Supplements and Natural Remedies

• Iron: Consider supplementation if deficient (get tested before trip)
• Ginkgo Biloba: Some studies suggest 100-120mg twice daily may help (start 5 days before ascent)
• Rhodiola: Adaptogenic herb that may improve oxygen utilization (500mg daily)
• Coca Leaf: Traditional remedy in Andean countries (tea or chewing leaves)
• Beet Root: May improve nitric oxide production and blood flow

Note: Discuss all supplements with healthcare provider before use; evidence for efficacy varies

Monitoring for Altitude Sickness

Self-Assessment Tools

• Lake Louise AMS Score: Standard assessment tool (score of 3+ with headache indicates AMS)
• Lake Louise Scoring System:
  • Headache: 0 (none) to 3 (severe, incapacitating)
  • Gastrointestinal symptoms: 0 (none) to 3 (severe nausea/vomiting)
  • Fatigue/weakness: 0 (none) to 3 (severe, limiting activities)
  • Dizziness/lightheadedness: 0 (none) to 3 (severe, incapacitating)
  • Sleep difficulty: 0 (normal) to 3 (unable to sleep)
  • Score of 3-5 = mild AMS; 6-9 = moderate AMS; 10+ = severe AMS

Physical Monitoring

• Pulse Oximetry: Normal at altitude is 90%+ (sea level is 95-100%)
  • 85-89%: Mild hypoxemia, monitor closely
  • 80-84%: Moderate hypoxemia, consider descending if symptomatic
  • Below 80%: Severe hypoxemia, strongly consider descent
• Pulse Rate: Elevated resting heart rate can indicate poor acclimatization
• Ataxia Test: Heel-to-toe walking in straight line (testing coordination)
• Edema Check: Monitor for swelling in hands, face, and ankles

Symptom Documentation

• Daily Log: Record symptoms, oxygen saturation, heart rate, and medications
• Buddy System: Have travel companions cross-check for symptoms
• Morning Assessment: Evaluate symptoms upon waking when AMS often peaks
• Trend Awareness: Watch for worsening symptoms or lack of improvement
• Group Monitoring: Establish system to regularly check on all group members

Emergency Response Protocols

When to Descend

• Moderate to Severe AMS: Lake Louise score of 6+ that doesn’t improve with treatment
• Any HACE or HAPE Symptoms: Mental status changes, ataxia, or severe breathlessness
• Pulse Oximetry: Persistent readings below 80% with symptoms
• Treatment Resistance: Symptoms that worsen despite medication and rest
• Extreme Fatigue: Inability to perform basic functions
• Descent Decision Rule: “When in doubt, get down”

Descent Guidelines

• Minimum Descent: At least 1,000-3,000 ft (300-1,000m) or until symptoms improve
• Descent Rate: As quickly as safely possible
• Assistance: Use assistance/support if victim has difficulty walking
• Rest During Descent: Only if absolutely necessary
• Continued Monitoring: Check symptoms regularly during descent
• Return Criteria: Do not reascend until completely symptom-free (usually 24-72 hours)

Emergency Treatment Options

• Supplemental Oxygen: Administer at 2-4 L/min if available
• Portable Hyperbaric Chamber: If available, use for the equivalent of a 5,000+ ft (1,500+m) descent
• Medication Protocol:
  • AMS: Acetazolamide 250mg immediately, then 125mg twice daily
  • HACE: Dexamethasone 8mg initially, then 4mg every 6 hours
  • HAPE: Nifedipine 10mg initially, then 30mg extended-release every 12 hours
• Position: Semi-sitting position for pulmonary edema, recovery position if unconscious
• Emergency Communication: Activate emergency response system if available

Special Considerations for Specific Groups

Children at Altitude

• Age Considerations: Children generally acclimatize at similar rates to adults
• Symptoms Recognition: Children may not clearly articulate symptoms
• Ascent Rate: Use same guidelines as adults, with more conservative approach
• Medication Dosing: Calculate acetazolamide at 2.5mg/kg/dose twice daily
• Hydration Monitoring: Pay extra attention to fluid intake
• Activity Level: Children may not self-regulate exertion; enforce rest periods
• Monitoring: Regular checks for non-specific symptoms (irritability, decreased appetite)

Older Adults at Altitude

• Pre-Trip Assessment: More thorough medical evaluation recommended
• Pre-Existing Conditions: Special attention to cardiovascular and respiratory issues
• Medication Review: Check for interactions with altitude medications
• Conservative Approach: Consider slower ascent profiles
• Rest Requirements: May need additional rest days
• Sleep Considerations: Greater focus on optimizing sleep environment
• Temperature Regulation: More attention to appropriate clothing layers

Individuals with Chronic Conditions

• Asthma: Carry sufficient inhalers; cold, dry air may trigger symptoms
• Diabetes: Altitude may affect glucose control; monitor blood sugar more frequently
• Hypertension: Monitor blood pressure; some medications may interact with altitude effects
• Heart Conditions: Consult cardiologist before travel; altitude increases cardiac workload
• Sleep Apnea: Consider bringing CPAP with battery backup; adjust settings for altitude
• Anemia: Consider iron supplementation before travel; more susceptible to hypoxia
• Pregnancy: Generally safe to moderate altitudes (8,000-10,000 ft/2,400-3,000m) with proper acclimatization

Destination-Specific Considerations

Popular High-Altitude Destinations

Regional Approach Strategies

• Himalayan Treks: Include scheduled acclimatization days at Namche Bazaar (11,286 ft/3,440m) and similar points
• Andean Travel: Consider Sacred Valley (9,514 ft/2,900m) before Cusco (11,152 ft/3,399m)
• Alpine Climbing: Use hut system for staged ascents; summit days from highest huts
• African Peaks: Choose routes with “climb high, sleep low” opportunities
• North American Mountains: Utilize established trailheads and campsite elevations for staging
• Air Travel to High Cities: Plan first 24-48 hours with minimal activity

Resources for Further Learning

Mobile Apps

• Altitude Alert: Tracks altitude and suggests acclimatization schedules
• iAltitude: Provides altitude-specific health information
• Pulse Oximeter Apps: Use phone camera to estimate oxygen saturation
• Peak Visor: Shows elevation profiles for hiking routes
• First Aid Apps: Red Cross or similar with high-altitude components

Books and Publications

• “Going Higher: Oxygen, Man, and Mountains” by Charles Houston
• “Altitude Illness: Prevention & Treatment” by Stephen Bezruchka
• “High Altitude Medicine and Physiology” by John B. West
• “UIAA Medical Commission Consensus Guidelines for Mountain Activities”
• Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care

Organizations

• International Society for Mountain Medicine
• Wilderness Medical Society
• UIAA Medical Commission
• American Alpine Club
• Himalayan Rescue Association

Training Courses

• Wilderness First Aid with altitude components
• Mountain Medicine certification courses
• High-altitude physiology workshops
• Expedition medicine training

Quick Reference: Altitude Sickness Prevention Checklist

One Month Before

• [ ] Medical check-up with healthcare provider
• [ ] Begin cardiovascular fitness training
• [ ] Research altitude profile of destination
• [ ] Obtain prescription medications if advised
• [ ] Check vaccination requirements

One Week Before

• [ ] Begin altitude medication if prescribed
• [ ] Pack all medical supplies and medications
• [ ] Review emergency evacuation information
• [ ] Download relevant altitude apps
• [ ] Check weather forecasts for destination

During Travel

• [ ] Stay well-hydrated during flights
• [ ] Avoid alcohol and excessive caffeine
• [ ] Begin documenting baseline vital signs
• [ ] Review symptoms of altitude illness
• [ ] Ensure all group members know protocols

Upon Arrival

• [ ] Plan 24-48 hours of reduced activity
• [ ] Establish hydration schedule
• [ ] Begin symptom monitoring routine
• [ ] Sleep at lowest practical elevation
• [ ] Maintain carbohydrate-rich diet