Altitude sickness death

How do you prepare for the rigorous physical requirements of high elevation adventure? Strength and endurance are key, but are only part of a more complex equation. How do you prepare for changes in altitude, exposure, diet, etc.? How do you mentally prepare? Learn from others and share what you know about training in advance for outdoor adventures.
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Re: Altitude sickness death

Post by giantbrookie » Fri Aug 17, 2012 9:26 pm

I think back to my hiking days as a kid and try to figure out whether if I was in the position of my dad I might have pulled the plug on a trip. Although the 2nd strongest hiker in the family after my dad, I was the most prone to altitude sickness of anyone in the family. I had some miserable day 1's, but I think, as noted by others, the telltale signs are the deterioration in later days such as day 3 plus and my day 2's and beyond were nearly all very strong. I almost never had much of an appetite at all on hiking trips in those days (say age 7 to 20). I'd hydrate OK, but I simply didn't eat much, whether I felt good or not (little wonder that I would lose lots of weight on those trips in those days--since the mid 90's I've eaten so well on trips that I seldom lose weight on them anymore). I had one trip where I didn't feel so hot on day 3--I threw up on the summit of Whitney on day 3 of a Mountaineers route family outing (age 11). In spite of that I believe I had altitude sickness but wasn't deteriorating otherwise as a result of something more serious such as HAPE--of course there wasn't a really good test given that my sickness climaxed at the summit and we descended reasonably fast after that (although our camp that night was still fairly high--est 12k somewhere below Iceberg L bivouacked among talus). Other than that I can't recall me or someone in my group having issues with altitude past day 1 or 2 on any trip I've been on over the 45 years I've been backpacking, thankfully. I have become sick in the backcountry beyond day 2, but these have been cases of the common cold, perhaps flu, and perhaps bacterial infections, rather than altitude sickness related (almost all of those examples are as an adult on trips taken aged 32-40). I guess I am partly thinking out loud to distinguish physical/health difficulties me or my hiking groups have had in the past from genuine symptoms that may have been the onset of HAPE--I sure hope I will be able to recognize the symptoms if indeed anyone in my group is suffering from them.


Since my fishing (etc.) website is still down, you can be distracted by geology stuff at: http://www.fresnostate.edu/csm/ees/facu ... ayshi.html" onclick="window.open(this.href);return false;






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Altitude sickness death

Post by Fishstick » Fri Aug 17, 2012 11:03 pm

A few years ago, we hiked up Whitney from the west on day 7 of a trip out of Mineral King. A 17 year old in our group was in great shape and had outpaced our group all week, even shuttling some packs up the passes for others who were exhausted. When we dropped packs on the ridge to hike the final mile to Whitney, he decided to show off by running. Ten minutes later, he was doubled up in cramped agony along the side of the trail. Several passers by told us "descend, descend, descend", so with an arm draped over two of our shoulders, he limped down the east side to the first base camp. An hour later, he was fine. A good reminder not to play fast and loose with the Mountains.

I'm not sure if this is anecdotal or scientific, but the times I have experienced altitude sickness symptoms (often after several days of acclamation) have been when I was in a hurry and didn't stop to eat or drink. It takes some conscious discipline, but if I intentionally slow the pace above 11k and routinely stop to drink and eat before I feel like it, I have not experienced the nausea and other effects. I may be mixing up routine fatigue with the more serious AMS and HEPE, but the practice has served me well in any event.

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Re: Altitude sickness death

Post by orbweaver » Sat Aug 18, 2012 3:48 pm

I'm thinking about AMS with respect to my forthcoming trip - in about 3 weeks. I'm planning to go North Lake to South Lake, over Piute Pass, down Piute Creek and up Evolution Valley, exiting through Bishop Pass - solo.

Some background - I'm a 69 year old hiker living in Florida. I'm in good health - not the strongest hiker but experienced and careful. I've just completed a week's hike between huts in Norway. I've been over Piute Pass twice for two day trips, the last time was last year, and I've had no AMS symptoms. I've acclimated at about approx. 9500 ft for two nights before these hikes and plan to do the same this year. I move slowly, drink a lot of water and eat snacks frequently.

What makes me nervous is going over Piute Pass and getting down to 8000 or 9000 feet, then developing symptoms as I go up to Muir Pass, say. I could go back down but wouldn't be able to get back to the eastern side of the Sierra without going up again.

I hadn't heard the idea of symptoms developing on the second night, then worsening a lot on the third day. This is new information for me. If I stay at 9500 for two nights, taking day hikes, then go over Piute Pass for a third night, and then wake up without symptoms (as I've done before), do you think I'm good to continue the rest of the loop?

Like others said, I don't want to hijack this thread, but I'm listening to the important message to be very careful of AMS.

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Re: Altitude sickness death

Post by rlown » Sat Aug 18, 2012 4:18 pm

To everyone with questions here especially about symptoms about AMS/HAPE/HACE and appropriate meds or approaches: We're not Doctors and I think most of you have one. Talk to them about past experience and appropriate approaches if the symptoms kick in.

WebMD is a fun site for background approaches, but it should still be a discussion with your doctor and you.

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Re: Altitude sickness death

Post by ManOfTooManySports » Sat Aug 18, 2012 4:54 pm

orbweaver (great name!), the good news is that if you do have to bail out, you can stay low and head out at Florence Lake. You'd have to string together some rides to get to the east side, but that would be the least of your problems.

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Re: Altitude sickness death

Post by overheadx2 » Sat Aug 18, 2012 10:55 pm

My post was not to have people second guess going (death is very rare) or be afraid to go, simply to let friends looking for packing info and advice know what to look for in case they happen to be that 1 in a million. I have never mentioned HAPE to any one asking for packing advice. Being susceptible to AMS myself, I usually don't feel great the fist night, but feel fine the next AM. If you wake the second or third day and continue to note decline, I would certainly monitor what's happening. As we have heard from several people, if you continue to decline over days, simply call it off and try another day. If you are solo, and have concerns, maybe a Delorme or spot is in order (probably not a bad idea on a solo trip any way).

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Re: Altitude sickness death

Post by Trent » Tue Aug 21, 2012 11:35 am

Reading all these replies,,,, there's a couple of things to be aware of that would apply to both AMS and injuries.

First of all, if you're "solo" in the backcountry and have the misfortune to break an ankle, get AMS [cerebral or pulmonary edema] or something, you're going to be a "permanent fixture" there unless you have some sort of "communication" with the outside world. I carry a sat phone [Iridium] and a ACR NOAA 406 mh rescue beacon. I've tested the sat phone in some very remote areas,,,, it's always worked.

The Sequoia / King's Canyon Park Service's "emergency" phone number, to be used ONLY if there's a true emergency, is 559/ 565-3195. While this may seem paranoic, consider that you may run across some other trekker in distress. The "Spot" things don't always work in the backcountry for some reason.

Secondly, if you have to be flown out [helicopter] be aware that they [the Sheriff's Department, Park Service, etc] are going to send you the bill. It ain't cheap, figure on $10,000 or so.

The answer to this is "Global Rescue insurance" 617/ 459-4200 [Globalrescue.com]. The deal is that if you are more than 160 miles from your "home base" [your residence] they will cover the cost of your "rescue", the cost of getting you to the hospital, and if need be the cost of getting you all the way back to your home. From virtually anywhere on the planet. It does not cover your medical expenses, just the rescue and transportation part.

I've got it, just hope I never have to use it.

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Re: Altitude sickness death

Post by AlmostThere » Tue Aug 21, 2012 11:45 am

Please stop telling people county search will charge. WE DO NOT.

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Re: Altitude sickness death

Post by acvdmlac » Wed Jul 15, 2015 1:42 pm

I am so sorry to learn about this terrible loss. My condolences to the family of the deceased. I can only imagine how painful this must be for the family and friends 4 years later and beyond.

What I have to add to this important thread, is to emphasize how much children and adolescents are more susceptible to altitude sickness (as well its sometimes co-morbid condition of dehydration/heat illness, hypothermia, or hyponatremia--sodium deficiency from a combination of sweating, excessive water consumption, and inadequate ingestion of salty foods). Children and adolescents are also less able to recognize, report, and communicate about symptoms, than adults.

These are obvious points once one stops to think about them, but I had not given them adequate consideration until I reached for the wilderness med hand-book in my first aid kit after my friend's fit, athletic, and stoic 14 year-old suddenly started complaining of severe fatigue, malaise and nausea and then started shivering and vomited fluids just after drinking about a half-liter of (tap) water, at our urging, at the end of a strenuous ascent in 6 hours over 6 miles, from an 8,000' trailhead to 10,600' Baker Lake (Great Basin National Park, Nevada, not Sierra in CA, but still relevant, I think).

He hadn't eaten or drunk much water that afternoon while we back-packed, but probably sweat profusely while he kept up with me, carrying a full back-pack, as I pushed my own limits to get to a camp-able site before dark (after a later-than-planned start and inability to locate campsites along the way as described in our trail guide). He had fallen asleep briefly when we arrived at the lake, and it was after being woken up by his father that he started complaining of nausea, and then vomited. His pulse was rapid, my partner (also a medical professional) estimated about 90 bpm (the second had on her watch was too small to read even by bright LED light--something to think about when selecting a time-piece for field use). He seemed slightly clumsy and lethargic, but not grossly uncoordinated. His mood and mental status seemed grossly normal, although I didn't check for full orientation. His respiration was of grossly normal rate and rhythm, without coughing, shortness of breath, headache, or muscle cramps. He did not want to drink fluids or eat, and attributed his vomiting to contamination of the water we had asked him to drink. This was his first back-packing experience at altitude. It was too dark to check reliably for cyanosis (blue lips and fingernails). I was assuming that altitude was the culprit, and did not reach for the thermometer in my kit. I don't recall any abnormal sweating.

After vomiting he was drowsy, just wanted to sleep, and was able to climb into his tent and lie down without further incident.

As a medical professional and experienced high-altitude back-packer, but without specific training in wilderness or altitude medicine, I at least recognized the severity and danger of the situation. I identified acute altitude sickness as the most likely and primary cause of his symptoms that should be assumed present, and recommended immediate descent. I offered to use my SAR beacon to call for emergency transport as the most rapid and safe option (night had fallen, and the 14-year old was in no shape to hike back down). His father declined, and luckily, his son slept well through the night was symptom-free the next day. We descended back to the trailhead the next morning without further incident.

The previous two nights we had car-camped at 7,500' and 6,500' (after starting from sea level), and the previous two days we were continuously above 5,000', including drive over 9,600' Sonora Pass, so I hadn't thought the altitude would have proved so much of a problem--it might not have for most adults, although we all had some mild and transient symptoms of altitude sickness by the time we got to 10,000' (no surprise to me). The weather was hot at the trailhead--I'd guess upper 80s, and probably reduced to low-60s by the time we got to Baker Lake at nightfall. Without any wind or water immersion, I wouldn't expect hypothermia as a risk at those temps. The water loss during hiking was probably more significant than I am used to in the Sierra Nevada--Nevada's Snake Range felt much drier.

In retrospect, I found my hand-book helpful only in confirming the severity of the situation, but inadequate in presenting a clear differential diagnosis between altitude sickness vs. hyper- or hypo-thermia and/or hyponatremia. There is some overlap in symptoms among all of them, and it seems that altitude sickness could be present simultaneously with any of the other 3. (I am also curious whether anyone know whether prior mild hyperthermia could make one more vulnerable to subsequent hypothermia following a severe temperature drop, as a consequence of over-compensation and disruption of the body's thermo-regulatory mechanisms). My recent experience tells me that the differentiation among these conditions is not as easy in an actual wilderness back-packing setting as it might seem in a textbook or clinic--yet critical to make rapidly and accurately, because the treatments are in some ways opposite (whether or not to administer heat vs. cold, fluids/type of food vs. not, etc.), depending on the cause. Mis-diagnosis/mis-management could prove fatal.

I am still researching and analyzing his signs and symptoms to try to better identify the likely relative contributions to this incident. I suspect too-rapid altitude ascent as the primary cause, exacerbated by a combination of dehydration, over-exertion, and over-compensation of the his thermoregulation during a rapid drop from hot to cool. I'll follow up with another post if/when I'm able to locate or present ways to more rapidly and reliably distinguish illness from heat- vs. cold- vs. altitude vs. exertion and hyponatremia--in the field with nothing more than a watch and a thermometer (that can give accurate readings by head-lamp), and simple knowledge that any lay-person could easily and rapidly make use of.

My suggestions for now: when planning back-packing or day-hiking with children and adolescents, consider their greater vulnerability to extremes and changes in weather and altitude; monitor their drinking, eating, exertion and fatigue levels carefully; stay extra-vigilant to early warning signs/symptoms, and don't presume that they can or will communicate regarding their symptoms the way most adults would.

Even for adults, I recommend more careful consideration of the risks of acute altitude sickness than I think is sometimes exhibited by trip recommendations that start with ascents to 10,000' + altitudes on Day 1 without reference to acclimatization for those coming from altitudes below 7-8,000'. Ascents over 10,000' + passes on Day 1 or even 2 are particularly dangerous because of the necessity to go back up and over the pass to get to lower altitude, unless one is prepared to call for emergency help, which is of course inconsistent with responsible trip-planning and advice.

I feel very grateful, relieved and lucky that my friend's son suffered no harm, and hope that this information will stimulate more discussion and awareness of these issues and prevent preventable and tragic losses such as described above.

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Re: Altitude sickness death

Post by Cross Country » Wed Jul 15, 2015 7:39 pm

Jim, 11 anos, Mike 6 anos and I went on two trips with no problems and I had neve experienced a problem in about 300 days during 15 years. On thier 3rd trip we drove from Sea Level to Onion Vally and went over Kearsarge Pass in the same day. They didn´t seem to be having big problems going up, but near the pass they were VERY tired. That night neither could eat dinner and went to bed a 7:30. They slept until 8 the next day. From the time they told me they couldn´t eat I knew I had made a big mistake. I altered our trip and we went to Charlotte Lake and stayed there 2 days instead of going to Gardner Basin. When we left they did fine and we hiked out to Onion. I was perfectly ready to stop at Kearsarge Lakes but they wanted to hike out. I learned a VERY cheap lesson and never did anything like that with them for the rest of thier backpacking lives (8 more years)

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