High-altitude emergencies

Even the hunting or camping trip of a lifetime could come to a screeching halt due to the effects of altitude. Whether an outdoorswoman or outdoorsman is scaling a 14,000-foot peak or trekking through the high mountain deserts, altitude may cause varying levels of illness that, if left untreated, can be hazardous or even lethal.

The majestic Colorado Rockies © Copyright 2009 Roy Tennant,
The majestic Colorado Rockies © Copyright 2009 Roy Tennant,

It is important to understand that altitudism is actually a series of three different syndromes.

Acute Mountain Sickness (AMS). This is the first tier of altitude-related syndromes. Who hasn’t experienced headache, nausea, vomiting and fatigue when trekking through mountainous terrain? Acute mountain sickness is a mild form of altitudism and is often self-limiting. While AMS may make the victim rather uncomfortable, it is not considered dangerous.  The symptoms of AMS are lessened with the following treatments:

Water, water, water . . . Water truly helps reduce the effects of AMS. Begin hydration prior to arriving at altitude. Continue to hydrate throughout the trip. High mountain regions are very dry, and the body suffers quite a bit of insensible fluid loss through breathing.

Rest . . . Let your body acclimate. Often, folks are trekking to the high country for some great outdoor adventure. Calculate a day or so into the itinerary at the beginning of the trip to allow the body to adjust.

Avoid caffeine and alcohol . . . They both further dehydrate the body and worsen the symptoms of AMS. As mentioned, AMS is mild and self-limiting. The aforementioned treatments can help reduce the duration and extent of the illness.

High Altitude Pulmonary Edema (HAPE). HAPE is the next level of altitude-related syndromes. HAPE can be lethal if undetected and untreated. HAPE is a result of a change in capillary pressures in the lungs, allowing fluid to “leak” into the lungs (this is called pulmonary edema). HAPE can occur not only at dizzying 14,000-foot heights, but is possible at elevations as low as 8,000 feet.

Furthermore, it is not very choosy about its victims.  HAPE can strike young, old, healthy or debilitated adventurers. Early identification is key.  Signs and symptoms of HAPE include fatigue, shortness of breath, tachypnea (rapid respiratory rate), cyanosis (bluish skin color due to lack of oxygen) and cough.  In time, the cough becomes frothy as the body tries to expel  fluid in the lungs.

As mentioned, if left untreated, HAPE can be lethal. So, how is it treated?

Go to the nearest urgent care clinic or emergency department. Do not pass go, do not collect $200. Time is of the essence.  Do not try to “sleep it off”: This can be a fatal mistake . . . I have seen it.

Once the victim is under medical supervision, treatment modalities include oxygen therapy and medications such as antihypertensives, steroids and diuretics. However, these treatments do not “cure” HAPE. The only cure for HAPE is to get to a lower altitude once the condition stabilizes.

The good news is that just because a person has had HAPE does not necessarily mean that he or she cannot venture to the high country again. Talk to your physician and see what he or she recommends. Ask about Diamox, a medication that is often used to blunt the effects of altitude prior to returning to the high country.

High Altitude Cerebral Edema (HACE). HACE is similar to HAPE, in that altitude changes the permeability of the blood vessels and allows fluids to leak into surrounding tissues. However, with HACE, this occurs in the brain rather than in the lungs. Symptoms can be insidious, and include fatigue, sleepiness, headache, confusion and ataxia (staggering gait). If left untreated, HACE can result in coma and death. Detection and immediate treatment in an emergency room are critical. It should be mentioned that HACE is very uncommon.

On a side note, I highly recommend that if an adventurer has any heart condition, he or she should consult a physician before traveling to the high country. Too often, travelers arrive at altitude too soon following a heart attack or recent heart surgery. Remember this: There is less oxygen at high altitudes, and it puts added stress on even a healthy heart to circulate the blood to allow oxygen to be delivered throughout the body. Throw a damaged or fragile heart into the mix, and the results can be devastating.

A trip to the mountains is usually a much-anticipated event. Plan well, listen to your body and seek medical treatment if necessary. Most of all, have a fabulous trip!

~Kirstie Pike, CEO Prois Hunting Apparel


  1. Kirstie
    I’m glad to see you recommending drinking plenty of water. A few years ago, I was disappointed to read an article in a hunting magazine by an outdoor writer and outfitter who recommended going into the high country dehydrated.

  2. Marilyn~
    Thanks so much for the comment! I am surprised that a responsible writer would go against current medical philosophy. If HAPE is going to strike, it will strike no matter what. Thus, staying healthy and hydrated is the best for the body and for warding off AMS symptoms which affect so many high-country visitors.

  3. Good article!
    One small point – there is no problem with caffeine at high altitude. Folks who use it regularly should continue it at altitude. Stopping caffeine causes withdrawal headache that mimics acute mountain sickness. Caffeine’s effect on hydration is very exaggerated. There is no diuretic effect in regular users, no more than the same volume of fluid of whatever kind. Alcohol, however, does produce a diuresis.
    Also, the value of drinking water at altitude is exaggerated. Yes, it’s good to stay hydrated, but it is bad to go over-board.

  4. Typically, it is recommended to retreat to a lower elevation to allow the body to recover. That said, it is not unreasonable to consider the same ascent on another trip or outing. Just consult your physician before doing so.

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