Mountain Sickness

[StG58]

Anyone ever get a serious case of Mountain (altitude) Sickness?

Just got my ass handed to me from this.

Edited to add:

I was visiting the daughter in Colorado. She lives at 7,600' within sight of the Front Range out by Colorado Springs. I live at 38' most of the time on the Oregon coast (give or take). This is road trip summer to visit friends and relatives and such between here and there, with side quests when interesting things pop up.

So, I'm a pretty old fat, but still feisty. I do have health issues that impact susceptibility to altitude sickness.

So, get up to the daughter's place, check out the horses, say hello to the dogs, have a whiskey with the son-in-law...set up the Airstream. Basically get settled in for a couple of weeks catching up and visiting.

First day and night, nothing notable happens. But as the week progresses, I'm dieing there. Go to sleep, wake up, can't breath, 02 levels in the 85% - range. Serious shit. I'm not happy. I used to climb mountains in the Cascades when I was younger. Not 14,000' mountains in the Rockies mind you, but 7,600' was low for a base camp back in the day.

After a week of this getting progressively worse I've got all the symptoms of pulmonary edema setting in, plus most of the symptoms of Altitude Sickness. (That will kill you by the way. Slowly.)

So, I dropped my altitude down to 6,000' and started a regimen of supplemental oxygen. Stabilized, but not improved.

Oh sent my Dr a message. He is a senior flight surgeon for the Oregon Air National Guard, He aughta' know something about Altitude Sickness, right? I get a very nice reply back from the practice legal team telling me that he cannot provide medical advice because he is only licensed in Oregon and Washington. WTF!? He can and has provided medical / surgical services in places and under circumstances all over the world, but he can't advise me because I'm not in Oregon!!??? Anyway...

After much research, it seems that Mountain sickness is a thing, and it can kill you. The only absolute way to successfully treat it is by getting to a lower altitude. It can make you wish you were dead, whilst making you think you are going there.

More details later... It's worth looking into, if you are going above about 8,000'. Even if you are acclimated, know the symptoms and talk to a medical professional before you get it.

Nuf' said.

 

[Granite]

I had it the first time I went up high in the Rockies. Felt like a hangover but I didn’t know it was deadly!
Now I respect it, take more time getting to 12k’+ and focus on hydration and it doesn’t bother me hardly at all. But it is definitely a thing!

 

[Rut Row]

Got it skiing in Utah. I was skiing with my buddy who is a Dr. I wanted to keep going but he insisted the day was over. That was a looong time ago too.

 

[Apparition]

Anyone ever get a serious case of Mountain (altitude) Sickness?

Just got my ass handed to me from this.

Edited to add:

I was visiting the daughter in Colorado. She lives at 7,600' within sight of the Front Range out by Colorado Springs. I live at 38' most of the time on the Oregon coast (give or take). This is road trip summer to visit friends and relatives and such between here and there, with side quests when interesting things pop up.

So, I'm a pretty old fat, but still feisty. I do have health issues that impact susceptibility to altitude sickness.

So, get up to the daughter's place, check out the horses, say hello to the dogs, have a whiskey with the son-in-law...set up the Airstream. Basically get settled in for a couple of weeks catching up and visiting.

First day and night, nothing notable happens. But as the week progresses, I'm dieing there. Go to sleep, wake up, can't breath, 02 levels in the 85% - range. Serious shit. I'm not happy. I used to climb mountains in the Cascades when I was younger. Not 14,000' mountains in the Rockies mind you, but 7,600' was low for a base camp back in the day.

After a week of this getting progressively worse I've got all the symptoms of pulmonary edema setting in, plus most of the symptoms of Altitude Sickness. (That will kill you by the way. Slowly.)

So, I dropped my altitude down to 6,000' and started a regimen of supplemental oxygen. Stabilized, but not improved.

Oh sent my Dr a message. He is a senior flight surgeon for the Oregon Air National Guard, He aughta' know something about Altitude Sickness, right? I get a very nice reply back from the practice legal team telling me that he cannot provide medical advice because he is only licensed in Oregon and Washington. WTF!? He can and has provided medical / surgical services in places and under circumstances all over the world, but he can't advise me because I'm not in Oregon!!??? Anyway...

After much research, it seems that Mountain sickness is a thing, and it can kill you. The only absolute way to successfully treat it is by getting to a lower altitude. It can make you wish you were dead, whilst making you think you are going there.

More details later... It's worth looking into, if you are going above about 8,000'. Even if you are acclimated, know the symptoms and talk to a medical professional before you get it.

Nuf' said.

An old coworker of mine got sick at Everest Base camp, he was medevacced out of there the night before that earthquake that killed a bunch of people at base camp.

I hiked from about 100' elevation to over 5300' in Alaska once and didn't feel like I had the energy I should have at the top but was able to get back down without issue. Had a I spent a week up there maybe something would have happened.

 

[Camdenst]

Be Safe, but if you need a chuckle... this was a great episode.


View: https://x.com/topgear_quoter/status/1713994716126056818

 

[suicideking]

I did wheel with a guy that discovered he had elevation sickness. We were running a trail in Big Bear, CA (mountains). Just casual conversation, walked up to him and asked how he was doing. Said he's having trouble breathing! Definitely an 'OH SHIT' moment.

Long story short, his dr. told him no more wheeling in the mountains. He had a history of heart problems and other issues.

 

[tworley]

I've never had it, but living in the Rockies probably helps

 

[NDSpeed]

I actually had a clients interpreter pass from the high altitude in Denver. Under lying problem of course.

But the altitude was ultimately what did him in.

 

[TJ4Jim]

Never realized that altitude had a direct affect on sleep which finally explained why I never could while staying in Santa FE, last time there we were walking around at a Farmers Market in town on a warm day and I had a meltdown out of nowhere and had to hang onto a tree trying to breathe normally while my wife went to get the truck. Not fun

 

[freedom_in_4low]

Curious about the underlying health issues that contribute because 7600' isn't usually associated with AMS. I wonder if you took more time to acclimate, whether it would be better tolerated, but unless you're just bored it's probably not practical to spend a week or two at 5000' just to go to 7600'. Fortunately you dont have to go too far in the springs area to drop 1500 or more feet so I bet you could sleep at 6000 and spend the day at 7600 with your daughter without much trouble.

This is not medical advice as I am not licensed in any state. I do struggle to sleep at 12k or above. I'm usually ok at 10k as long as I spend a night at 6k first. I'm also 42 and reasonably fit.

 

[StG58]

Ya, underlying cardio pulmonary issues, half my diaphragm is paralyzed so that drops lung function by 25 percent right off the top. I'm 69 and pretty fir for an old guy. But still 30 pounds over fighting weight.

As close as I can tell it was not enough water, to much whiskey up front, and trying to tough through the symptoms. Oh, and ignorance on what was actually going on.

The supplemental oxygen was actually hindering, not helping.

Dropping to 6,000 feet helped some, but by that time the chemical byproducts had accumulated enough that 24 hours at that altitude wasn't enough.

I've dropped down to 5,000' now, and feel almost spry. Coughing up crap and clearing my lungs.

I did a bunch of research last night. Might write it up and post it here for giggles.

 

[freedom_in_4low]

Ya, underlying cardio pulmonary issues, half my diaphragm is paralyzed so that drops lung function by 25 percent right off the top. I'm 69 and pretty fir for an old guy. But still 30 pounds over fighting weight.

As close as I can tell it was not enough water, to much whiskey up front, and trying to tough through the symptoms. Oh, and ignorance on what was actually going on.

The supplemental oxygen was actually hindering, not helping.

Dropping to 6,000 feet helped some, but by that time the chemical byproducts had accumulated enough that 24 hours at that altitude wasn't enough.

I've dropped down to 5,000' now, and feel almost spry. Coughing up crap and clearing my lungs.

I did a bunch of research last night. Might write it up and post it here for giggles.

Yeah, that'll do it, and whiskey and lack of water definitely weren't doing you any favors.

My dad used to have A-fib, had several electro cardio conversions and two ablations to get him back out, but at least two of the times he went in, happened in the rockies, a third happened after donating blood (the vampires disguised as charity workers won't tell you that, but it can actually be pretty stressful on your heart) . Seems to be good now after the second ablation and a pacemaker. All that to say the impact of elevation on cardio is real.

 

[StG58]

I had AI help me with this.

Here is an expanded draft that weaves in the earlier field checks, the mechanics of HACE/HAPE, and the Diamox/kidney loop so the entire progression is wrapped up into one comprehensive field guide.
# FIELD LESSON & TECHNICAL NOTE: High-Altitude Physiology, Diagnostic Checks, and the "Oxygen Shield" Trap

**OPERATIONAL PARAMETERS:** Rapid/Staged Ascent from ~Sea Level (38 ft) to Mountain Basecamp (7,600+ ft)

**OBSERVATION:** Complete lack of natural altitude acclimatization despite 3+ weeks in the field.

**CORE MECHANISM:** Supplemental oxygen (O_2) usage during rest creating a localized "sea-level bubble" and overriding blood chemistry adaptation.

## 1. ATMOSPHERIC REALITY: Pressure vs. Concentration

A common misconception is that high-altitude air has less oxygen percentage. The air composition remains **~21% O_2** whether at sea level or 14,000 feet.

* **The Real Variable:**

**Barometric pressure.** Lower pressure at elevation reduces the force pushing oxygen across the lung membranes into red blood cells, causing blood oxygen saturation (SpO_2) to drop.

* **The Body’s Response:** The brain detects low O_2 and increases respiration rate. However, hyperventilation blows off carbon dioxide (CO_2). Loss of CO_2 causes **respiratory alkalosis** (blood becomes too alkaline).

* **The Acclimatization Trigger:** To fix this, the kidneys must excrete bicarbonate over 48–72 hours to restore blood pH balance, allowing the brain to maintain an elevated breathing rate day and night.

## 2. THE CAUSE: The "Oxygen Shield" Vulnerability

Using supplemental O_2 (via concentrator or bottle) during routine basecamp rest or sleep disrupts this natural loop:

1. **Artificially High FiO_2:** Flooding the lungs with supplemental oxygen compensates for low atmospheric pressure, keeping SpO_2 artificially high.

2. **Kidney Signal Blocked:** Because the body never senses sustained, mild hypoxia, the kidneys never get the signal to dump bicarbonate. Blood pH stays unadjusted, and baseline respiration stays at sea level.

3. **The Adaptation Pause:** The body's natural acclimatization clock is frozen. The moment the O_2 bottle runs empty, power fails, or a regulator freezes, the un-acclimatized body drops instantly into severe hypoxia—creating a high-risk single point of failure.

## 3. ADVANCED FIELD DIAGNOSTICS: Catching AMS, HAPE, and HACE Early

When operating in remote camps, catching severe altitude complications early—without clinical equipment—relies on basic physical checks.

### A. Acute Mountain Sickness (AMS)
* **Symptoms:** Throbbing headache, nausea, fatigue, insomnia. Feels like a severe hangover.

* **Protocol:** Do not ascend further. Rest, hydrate, and allow 24–48 hours for blood chemistry to adjust.

### B. High-Altitude Cerebral Edema (HACE) — *Brain Swelling*

* **The Field Test:** **Heel-to-Toe Tandem Gait.** Have the individual walk 10–15 steps in a straight line, heel directly touching toe with each step.

* **Red Flag:** Stumbling, swaying, or total loss of balance (ataxia). Any failure of the tandem gait at altitude is treated as HACE until proven otherwise.

* **Protocol:** **Immediate descent is mandatory.**

### C. High-Altitude Pulmonary Edema (HAPE) — *Fluid in Lungs*

* **The Field Test:** **Resting Breathlessness & Lung Check.** Observe the person sitting quietly for 3 minutes.

* **Red Flag:** Severe breathlessness at rest (respiratory rate >20–25 bpm) or a wet, crackling sound in the chest (audible by putting your ear against their upper back between the shoulder blades). A persistent wet cough or frothy sputum is a late-stage crisis.

* **Protocol:** **Immediate descent is mandatory.**

## 4. PHARMACOLOGICAL & O2 MECHANICS RECAP

| Tool / Intervention | Primary Mechanism | Best Practical Use Case | Key Considerations |
|—-|—-|—-|—-|
| **Acetazolamide (Diamox)** | Forces kidneys to dump bicarbonate, inducing mild metabolic acidosis to "trick" the brain into breathing faster. | **Prevention.** Speeds up natural 48–72hr acclimatization window. | Acts as a diuretic; causes harmless "pins and needles" tingling in extremities and flattens carbonated drinks. |
| **Supplemental Oxygen (O_2)** | Elevates fractional oxygen concentration (FiO_2) to override low barometric pressure. | **Emergency Stabilization / Evacuation.** Instantly reverses brain hypoxia and lowers pulmonary vascular pressure. | **Hinders long-term adaptation.** Masks symptoms and prevents natural acclimatization if used casually during routine rest. |

## 5. SUMMARY & FIELD PROTOCOL
1. **Treat O_2 as Medical, Not Routine:

** Use supplemental oxygen to stabilize sick individuals or manage emergencies, not as a substitute for natural acclimatization.

2. **Execute the Reset:** To acclimate properly at basecamp (~7,600+ ft), phase out supplemental O_2 during rest. Allow 48–72 hours for respiration to naturally adjust and blood pH to settle.

3. **Hydrate Continuously:**

Respiration loss and renal bicarbonate excretion drain fluids rapidly. Increase water and electrolyte intake significantly during the transition phase.

4. **The Golden Rule:** *Ascent is optional; descent is mandatory.* If ataxia or resting breathlessness develops, drop elevation immediately.

 

[Mhass]

Ugh!
No fun
I grew up in Wyoming and never had issues hiking, camping, hunting, cycling and running all over the Rockies and Tetons.
Then, the Navy moved me to the coast and I spent 40 years at sea level. Oh, I also got old! Still, I'm pretty fit and thought I wouldn't have any issues visiting my brother in Evergreen, CO.
I mean, I can pull off a sub 4 hour marathon at 61, so a little altitude should be no problem, right?
Wrong! Last time I was there, I ended up in the hospital thinking I had meningitis again.
Recurring viral meningitis is one of the lasting gifts i have from an infection in Haiti. I have some other leftover issues from oil fires and such from my time in the Navy. Decreased lung and kidney function is no Bueno at higher altitudes.
Still, I thought I could tough it out and it landed me in the hospital.
Embarrassing as hell, but very real.

 

[MikeE024]

I was already pretty sick when I climbed Mt. Fugi, so I couldn't tell you how the elevation effected me. My fever broke around 10,000 feet, and my first taste of Miso soup that a monk handed me at the top was glorious.

I do recall spending time in Granby CO years ago, and a few of us felt like we had a light hangover while sitting in a hot tub shortly after arriving. I don't recall doing anything special to overcome it other than getting out of the dehydration device, but it's good to know that lowering your elevation helps when things turn for the worst.

 

[freedom_in_4low]

I had AI help me with this.

Here is an expanded draft that weaves in the earlier field checks, the mechanics of HACE/HAPE, and the Diamox/kidney loop so the entire progression is wrapped up into one comprehensive field guide.
# FIELD LESSON & TECHNICAL NOTE: High-Altitude Physiology, Diagnostic Checks, and the "Oxygen Shield" Trap

**OPERATIONAL PARAMETERS:** Rapid/Staged Ascent from ~Sea Level (38 ft) to Mountain Basecamp (7,600+ ft)

**OBSERVATION:** Complete lack of natural altitude acclimatization despite 3+ weeks in the field.

**CORE MECHANISM:** Supplemental oxygen (O_2) usage during rest creating a localized "sea-level bubble" and overriding blood chemistry adaptation.

## 1. ATMOSPHERIC REALITY: Pressure vs. Concentration

A common misconception is that high-altitude air has less oxygen percentage. The air composition remains **~21% O_2** whether at sea level or 14,000 feet.

* **The Real Variable:**

**Barometric pressure.** Lower pressure at elevation reduces the force pushing oxygen across the lung membranes into red blood cells, causing blood oxygen saturation (SpO_2) to drop.

* **The Body’s Response:** The brain detects low O_2 and increases respiration rate. However, hyperventilation blows off carbon dioxide (CO_2). Loss of CO_2 causes **respiratory alkalosis** (blood becomes too alkaline).

* **The Acclimatization Trigger:** To fix this, the kidneys must excrete bicarbonate over 48–72 hours to restore blood pH balance, allowing the brain to maintain an elevated breathing rate day and night.

## 2. THE CAUSE: The "Oxygen Shield" Vulnerability

Using supplemental O_2 (via concentrator or bottle) during routine basecamp rest or sleep disrupts this natural loop:

1. **Artificially High FiO_2:** Flooding the lungs with supplemental oxygen compensates for low atmospheric pressure, keeping SpO_2 artificially high.

2. **Kidney Signal Blocked:** Because the body never senses sustained, mild hypoxia, the kidneys never get the signal to dump bicarbonate. Blood pH stays unadjusted, and baseline respiration stays at sea level.

3. **The Adaptation Pause:** The body's natural acclimatization clock is frozen. The moment the O_2 bottle runs empty, power fails, or a regulator freezes, the un-acclimatized body drops instantly into severe hypoxia—creating a high-risk single point of failure.

## 3. ADVANCED FIELD DIAGNOSTICS: Catching AMS, HAPE, and HACE Early

When operating in remote camps, catching severe altitude complications early—without clinical equipment—relies on basic physical checks.

### A. Acute Mountain Sickness (AMS)
* **Symptoms:** Throbbing headache, nausea, fatigue, insomnia. Feels like a severe hangover.

* **Protocol:** Do not ascend further. Rest, hydrate, and allow 24–48 hours for blood chemistry to adjust.

### B. High-Altitude Cerebral Edema (HACE) — *Brain Swelling*

* **The Field Test:** **Heel-to-Toe Tandem Gait.** Have the individual walk 10–15 steps in a straight line, heel directly touching toe with each step.

* **Red Flag:** Stumbling, swaying, or total loss of balance (ataxia). Any failure of the tandem gait at altitude is treated as HACE until proven otherwise.

* **Protocol:** **Immediate descent is mandatory.**

### C. High-Altitude Pulmonary Edema (HAPE) — *Fluid in Lungs*

* **The Field Test:** **Resting Breathlessness & Lung Check.** Observe the person sitting quietly for 3 minutes.

* **Red Flag:** Severe breathlessness at rest (respiratory rate >20–25 bpm) or a wet, crackling sound in the chest (audible by putting your ear against their upper back between the shoulder blades). A persistent wet cough or frothy sputum is a late-stage crisis.

* **Protocol:** **Immediate descent is mandatory.**

## 4. PHARMACOLOGICAL & O2 MECHANICS RECAP

| Tool / Intervention | Primary Mechanism | Best Practical Use Case | Key Considerations |
|—-|—-|—-|—-|
| **Acetazolamide (Diamox)** | Forces kidneys to dump bicarbonate, inducing mild metabolic acidosis to "trick" the brain into breathing faster. | **Prevention.** Speeds up natural 48–72hr acclimatization window. | Acts as a diuretic; causes harmless "pins and needles" tingling in extremities and flattens carbonated drinks. |
| **Supplemental Oxygen (O_2)** | Elevates fractional oxygen concentration (FiO_2) to override low barometric pressure. | **Emergency Stabilization / Evacuation.** Instantly reverses brain hypoxia and lowers pulmonary vascular pressure. | **Hinders long-term adaptation.** Masks symptoms and prevents natural acclimatization if used casually during routine rest. |

## 5. SUMMARY & FIELD PROTOCOL
1. **Treat O_2 as Medical, Not Routine:

** Use supplemental oxygen to stabilize sick individuals or manage emergencies, not as a substitute for natural acclimatization.

2. **Execute the Reset:** To acclimate properly at basecamp (~7,600+ ft), phase out supplemental O_2 during rest. Allow 48–72 hours for respiration to naturally adjust and blood pH to settle.

3. **Hydrate Continuously:**

Respiration loss and renal bicarbonate excretion drain fluids rapidly. Increase water and electrolyte intake significantly during the transition phase.

4. **The Golden Rule:** *Ascent is optional; descent is mandatory.* If ataxia or resting breathlessness develops, drop elevation immediately.

Nice summary. I had my wife use acetazolamide once on a hiking trip to 14k... She was inexperienced and unacclimatized but ended up having no AMS symptoms and slept ok at 12k. She did get it a bit when we drove to the top of Mauna Kea. She just had the headache and a little nausea so we grabbed some photos and headed down. Going from sea level to 13000 in a couple of hours is hard to do almost anywhere else in the US.

My brother goes to Colorado all the time but got it once riding the pikes peak cog railway. He was pulling the car over to puke until he got out onto the plains east of I-25.

I knew o2 was generally ineffective but never knew it was actually a negative. Really interesting information.

 

[sab]

I've never had a case of altitude sickness, but since I spent many years chasing critters in the mountains as a flatlander, I am well aware of it. I never worried too much about it if I was driving to the mountains because the drive allowed for gradual acclimation. However, a few times I flew in, and in those cases, I took a supplement called Altitude Advantage. I don't know if it worked because I don't seem to be affected by the altitude, but in those "fly-in" cases, where I got on a plane at 7am, and by noon I was at 10k feet, I never got sick.

Now let's talk about altitude diuresis. Not a serious problem, but this one gets me every time. In fact, Mrs. sab and I just returned from a camping trip to the mountains, and one of our camps was at 9k feet. We both were up every 2 hours to pee. It's tough to function on 2 hour blocks of sleep!

 

[sab]

I had my wife use acetazolamide once on a hiking trip to 14k...She just had the headache and a little nausea...

I stayed away from using Diamox because nausea is one of the common side effects, and since it's also a symptom of altitude sickness, I didn't want a medication to falsely convince me that I had altitude sickness starting (I spent a lot of time preparing for my hunts, and the last thing I wanted to do was bail on a hunt.)

 

[freedom_in_4low]

I stayed away from using Diamox because nausea is one of the common side effects, and since it's also a symptom of altitude sickness, I didn't want a medication to falsely convince me that I had altitude sickness starting (I spent a lot of time preparing for my hunts, and the last thing I wanted to do was bail on a hunt.)

I don't know how commonly AMS causes nausea without also having a headache, but that may be a valid concern. She only had the pins and needles when she took it.

Other than poor sleep the first night, the headache is really all I've ever had at elevation, and that's only been in the final summit push at 14k after hours of heavy exertion, in years when I lived below 1200' and was just visiting. It never happened when I lived at 5000+.

 

[Rooscooter]

Well... there is "Altitude Sickness" and Acute Mountain Sickness". Related but physiological reactions are very different.

Back in the day I worked summers in Sun Valley Idaho for a hunting/fishing/rafting guide service. I usually was the grunt who put into the Salmon River 5 hours ahead of the Wall Street executives and their families to build a base camp for them and start dinner 25 miles down river on a 7 day "River of no Return" trip. I also taught fly fishing for beginners and finally a few times I went along with the "climbers" on some of the hikes of the Sawtooth mountain peaks. We all had to be EMS training as part of the job.

So, one time on one of the few climbs I did with the customers and guides we had a guy nearly die and we had to get him down to a place where he could be airlifted off the mountain. He developed significant acute issues associated with cerebral edema... which is part of High Mountain Sickness. That was between roughly 9K and 10.5K (Thompson Peak).

Fun part of climbing at high altitudes is the swelling of the body... I didn't much care for it so I stayed in the rafts after that.