When Should You Go to the Doctor for Altitude Sickness?

1. Severe acute mountain sickness

Severe AMS is an emergency that needs immediate medical attention. Symptoms of severe AMS may include:

• Shortness of breath, even while resting
• Inability to walk
• Confusion
• Fluid buildup in the lungs or brain

If you experience these symptoms, you descend to a lower altitude immediately and consult a doctor. Hospitalization may be necessary in some cases.

2. High-altitude cerebral edema 

HACE is a severe form of altitude sickness caused by leaking capillaries in the brain, resulting in fluid accumulation and swelling. HACE generally occurs 1-3 days after climbing above 9,800 feet. Symptoms of HACE may include:

• Extreme exhaustion
• Headache
• Hallucinations
• Psychotic behavior
• Drowsiness
• Confusion
• Irritability
• Unsteady gait

If you notice these symptoms, stop climbing immediately and go down to a lower altitude. While you are about to descend, you may experience worsened symptoms that can make it difficult to walk. preventing your gait. 

3. High-altitude pulmonary edema

HAPE is a rare, potentially fatal condition that involves leaking lung capillaries, resulting in fluid accumulation in the lungs. HAPE can occur when you rapidly climb altitudes above 8,200 feet. Symptoms usually begin 2-4 days after arriving at the altitude. You may or may not experience symptoms of AMS along with HAPE. You may observe these symptoms if you have HAPE:

• Coughing up pink, frothy sputum
• Breathlessness with activity
• Difficulty walking uphill
• Cyanosis (skin or nails start to turn blue)
• Confusion and irrational behavior
• Chest tightness
• Extreme fatigue and weakness
• Feeling of choking 

As symptoms worsen, you may experience shortness of breath even while resting. Delaying medical attention can be life-threatening and even cause death. 

• Mild AMS: Symptoms usually resolve within 1-2 days as your body adjusts to the altitude and may include:
  • Dizziness
  • Shortness of breath
  • Loss of appetite
  • Problems sleeping
• Moderate AMS: Symptoms tend to worsen over time and include:
  • Fatigue, weakness, and difficulty breathing
  • Severe headache, nausea, and vomiting
  • Chest tightness or congestion
  • Coordination issues
  • Difficulty doing regular activities though you may be able to walk independently
• Severe AMS: Symptoms are most severe in this stage and require immediate descent and medical attention:
  • Extreme fatigue
  • Severe difficulty breathing even at rest
  • Difficulty walking

As you descend to lower altitudes, the following methods can ease symptoms and prevent them from worsening:

• Supplemental oxygen: If available, you can use supplemental oxygen to support your breathing during the descent.
• Portable hyperbaric chamber: This is an inflatable bag where the affected person is zipped inside the chamber, and the bag is inflated with a foot pump. As the bag inflates, you experience a lower altitude air pressure, allowing you to breathe more easily. The oxygen level in the body gets restored, reducing the  symptoms of HACE. Treatment in a portable hyperbaric chamber can be lifesaving until climbing down is possible.
• Dexamethasone: If you plan to sleep above 9,800 feet, this drug is a must in your first aid kit. Take 8- to 10-mg tablets by mouth as soon as you notice signs of HACE. After the initial dose, take 4 milligrams every 6 hours until you have descended. 

It’s also important to stay warm and rest frequently if possible. If none of the treatment measures are available, medications such as nifedipine, tadalafil, dexamethasone, or acetazolamide may help reduce headaches and nausea.

If you have a history of altitude sickness, take precautions before ascending to higher elevation. Ascending slowly allows your body to get accustomed to changes in oxygen levels at different altitudes.

You can also take acetazolamide or dexamethasone 5 days before travelling. Other recommendations include::

• Don’t stop drinking caffeine if you consume it regularly, as stopping may worsen your symptoms.
• Climb high during the day but return to a lower elevation to sleep at night.
• Avoid alcohol or sleeping pills, especially in the first 2 days while your body is adjusting to the altitude.