29 September 2016

Why is altitude sickness so dangerous?

Following Gugu Zulu's death, altitude sickness is in the spotlight, highlighting the fact that this illness is more serious than most of us realise.


The recent tragic death of South African racing car driver Gugu Zulu on Mount Kilimanjaro has drawn significant public interest and speculation about the risks of high-altitude trekking and climbing.

Kilimanjaro is of particular relevance, as it has a very high incidence of altitude-related illnesses.

Also known as acute mountain sickness (AMS), altitude sickness is a group of illnesses caused by low oxygen partial pressures, due to ascent to altitude without adequate acclimatisation. “Any altitude above 3000 m may induce AMS,” says Dr Rik Decker, a consultant paediatric cardiologist and director of the Cardiac Catheterisation Laboratory at UCT.

Read more: Altitude sickness

“The group includes mild (temporary) AMS, which may worsen to high altitude pulmonary oedema (HAPE) and high altitude cerebral oedema (HACE), both of which may be fatal. Some include high altitude retinal haemorrhage (bleeding).”

‘Up and down quickly’

According to Decker nausea, vomiting, cough, shortness of breath (unrelated to exercise), sleep disturbance and headaches are common symptoms.

“These vary (unpredictably) from person to person and according to the speed of ascent to high altitude. By far the most dangerous warning sign is a guiding company that plans to get you ‘up and down quickly’, with a fixed itinerary,” says Decker.

“Never climb a big mountain to a fixed itinerary – you are merely a guest granted the privilege to spend some time in a very dangerous environment. Maximise your safety by taking it slowly.  A recommended ascent rate is maximum 500 m ascent per day above 3000 m, with a rest day every third day.”

Your ascent rate should depend on conditions (both your physical condition and the mountain/terrain condition).

Read more: Genes linked to chronic altitude sickness


There are also a lot of myths associated with this condition and this is “among not only the lay public, but also medical professionals”. Common myths are:

  • Fitness protects you from AMS
  • Previous exposure to altitude without developing AMS means you are safeguarded for life
  • Diamox (Acetazolamide) will protect you so that you can ascend faster
  • Drinking a lot of water helps
  • The mountain guide always knows best
  • Children are more susceptible to AMS – so adults won’t get it
  • If you get AMS, you should just go down and you will be okay

Prevent AMS

A good tip is to consciously hyperventilate at all times. Stay well hydrated and stay focused.

“Get to your next campsite early, rest for a while and then ascend above your campsite slowly for another 100–200 m, remain there for an hour or two, and then descend to sleep at your campsite,” says Decker.

“If you feel mildly unwell, wait for a day. If it’s bad, or worsens, go down as soon as you can.”

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