High altitude treatment: quick, practical steps to stay safe

Heading into the mountains? High altitude causes real problems for some people. The good news: most cases are preventable and treatable if you know the signs and act fast. This page gives clear, usable steps for preventing altitude sickness and what to do if symptoms start — from simple rest and hydration to meds, oxygen, and emergency descent.

Prevent it first — simple routines that work

Start slow. Above about 3,000 meters (10,000 ft), don’t climb more than 300–500 meters (1,000–1,600 ft) per day. Take a rest day every 1,000 meters you gain. Follow “climb high, sleep low” — hike up during the day but sleep lower when you can.

Hydrate and eat well. Drink regularly (thirst is a late sign). Avoid heavy alcohol and sedatives before and during ascent — they make breathing problems worse. Pace your activity for the first 24–48 hours: don’t push hard on day one at high altitude.

Consider acetazolamide (Diamox) for prevention if you’re prone to problems or making a fast ascent. A common dose is 125 mg twice daily, started 24 hours before ascent or at bedtime the night before. Some use 250 mg twice daily; check with a healthcare provider. Don’t take it if you have a severe sulfa allergy or ask your doctor if you’re pregnant or have kidney disease. Expect mild side effects like tingling in hands/feet and increased urination.

Treating symptoms — what to do right away

Recognize mild acute mountain sickness (AMS): headache, nausea, poor sleep, dizziness. If symptoms are mild, stop climbing and rest at the same altitude. Simple remedies: rest, extra fluids, acetaminophen or ibuprofen for headache, and acetazolamide if prescribed.

If symptoms get worse (worsening headache, vomiting, severe weakness or confusion), act fast. The two life‑threatening conditions are HAPE (high-altitude pulmonary edema) and HACE (high-altitude cerebral edema).

Signs of HAPE: breathlessness at rest, cough producing frothy or pink sputum, fast breathing. For HAPE: descend immediately, give oxygen if available (aim for higher SpO2 but treat symptoms, not numbers), and consider nifedipine slow‑release (often 20 mg every 8–12 hours) only under medical advice. Portable hyperbaric bags (Gamow bag) can help if descent or oxygen isn’t possible.

Signs of HACE: confusion, trouble walking (ataxia), severe headache, personality changes. For HACE: descend immediately and give dexamethasone if available — typical emergency dose is 8 mg once, then 4 mg every 6 hours — but always get medical help as soon as possible. Dexamethasone can buy time but is not a substitute for descent.

Carry a small kit: pulse oximeter, basic meds (pain reliever, anti-nausea), acetazolamide if prescribed, and a plan for rapid descent. Know the nearest clinic or rescue service on your route. If in doubt, descend — it’s the safest choice.

Want a personal plan? Talk with your doctor before travel, especially if you have heart or lung disease. With sensible pacing, hydration, and a clear emergency plan, most people enjoy the high places safely.