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Altitude sickness is common in people who travel to high elevations, such as hikers, mountain climbers, or skiers. Symptoms include headache, dizziness, nausea, fatigue, and shortness of breath.

Alcohol may make it more difficult to acclimate to higher altitudes. But altitude has not been proven to make the effects of alcohol more potent.

To stay safe when traveling to higher altitudes, make sure you know the signs of altitude sickness. Drink plenty of water, ascend slowly, and refrain from tobacco, alcohol, or medications that depress breathing.

What Is Altitude Sickness?

Altitude sickness is a condition that can develop when you travel above 8,000 feet or 2,500 meters.1

Altitude sickness occurs because the body is not able to adapt quickly enough to the lower air pressure and lower oxygen levels in the air at higher altitudes. At significant elevation, a person’s breathing rate increases to help maintain blood oxygen levels. Despite this automatic physiological response, however, blood oxygen may remain below normal levels. As a result, the body must function with less oxygen than it usually does.2

Most people who develop altitude sickness will experience acute altitude sickness or acute mountain sickness, which is a set of symptoms that develop within 6-12 hours after ascent and dissipate over a period of 1 to 3 days if they do not ascend any higher.3,4

Symptoms include:1,2

  • Headache.
  • Dizziness.
  • Nausea.
  • Fatigue.
  • Reduced appetite.
  • Shortness of breath.

About 20% of people who ascend to 2,500 meters develop altitude sickness, and about 40% of people who ascend to 3,000 meters in one day develop altitude sickness.4

Risk factors for altitude sickness include:4

  • Living near sea level.
  • Ascending too fast.
  • Overexertion.
  • History of altitude sickness.
  • Sleeping at high altitudes.

Physical fitness is not known to protect against altitude sickness.4

Other more serious—but rare—conditions that can develop at high altitudes include pulmonary edema and cerebral edema. These 2 conditions can occur when fluid builds up in the lungs or the brain, respectively, and they require immediate medical attention.1

Symptoms of pulmonary edema include:1

  • Shortness of breath.
  • Coughing.
  • Producing frothy or blood-stained sputum.

Symptoms of cerebral edema include:1

  • Confusion.
  • Loss of coordination.
  • Decreased level of consciousness.
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Alcohol and Altitude Sickness

There has been some speculation about a connection between alcohol and altitude sickness ever since R.A. McFarland, a Columbia University psychologist, concluded that 2 or 3 cocktails would have the effect of 4 or 5 drinks at an altitude of 10,000 to 12,000 feet. In the meantime, there has been limited research to back up his claim.5

  • One study in Austria suggested that altitude doesn’t affect how alcohol is metabolized by the body. It found that participants’ blood alcohol level was almost the same at sea level and at nearly 10,000 feet after drinking 1 liter of beer.5
  • Another study by the Federal Aviation Administration found that alcohol and altitude affected the performance of pilots, but there was very little interaction between the two.5

However, alcohol may exacerbate some of the effects associated with altitude sickness or make it more difficult to acclimate to elevated conditions.

  • The Austrian study found that participants who drank had slightly impaired breathing compared to participants who didn’t, which could lead to hypoxia (oxygen deficiency) since people need to breathe more at higher altitudes to compensate for less oxygen.5
  • A study from the journal PloS One found that people who drank alcohol while acclimating to high altitudes had higher blood pressure than nondrinkers.6

More research needs to be done to fully understand the interaction between alcohol and altitude sickness. But it does not appear that alcohol becomes more potent at higher altitudes or that the body has more trouble processing it. That said, people may feel relatively more impaired because the symptoms of alcohol intoxication, such as dizziness, closely resemble the effects of altitude sickness.

Experts recommend that you avoid alcohol if you are ascending to higher altitudes, particularly before bed.4 To be safe, wait 48 hours after you ascend to a higher elevation to drink, and avoid opioids (OxyContin, Vicodin) and benzodiazepines (Xanax, Klonopin) as these can cause respiratory depression. Two days is normally enough time for your body to acclimate to the altitude.7

Higher elevations also have less moisture in the air, which when combined with alcohol consumption increases the risk of dehydration. So be sure to drink plenty of fluids after you’ve ascended.7

How to Prevent and Treat Altitude Sickness

Research has shown that the best way to prevent altitude sickness is to ascend at a slow pace. Quick ascension has been associated with higher risk of developing altitude sickness. At levels above 2,500 meters, people predisposed to altitude sickness can generally tolerate an ascent rate of 400-500 meters a day when they are not traveling higher than 5,000 meters.8

Medications may also be used to prevent altitude sickness. Acetazolamide (Diamox), a carbonic anhydrase inhibitor commonly used to treat glaucoma, can also be used to prevent altitude sickness and relieve symptoms by increasing ventilation and therefore oxygen intake. People can take it before ascent and at bedtime.2,4

Dexamethasone, a steroid regularly used as an immunosuppressive agent, as well as to decrease inflammation and swelling, may also be used to help manage altitude sickness.4

Altitude sickness can be treated by descending to a lower altitude, administering supplemental oxygen, or using portable pressure bags to raise the pressure of inhaled air. Mild symptoms usually improve within 1-2 days after descent with rest and treatment. People with severe altitude sickness or signs of pulmonary or cerebral edema should receive medical care immediately.2,8

Additionally, over-the-counter pain relievers such as ibuprofen and acetaminophen can be used to treat altitude-related headaches.4

Sources

[1]. Murdoch, D. (2010). Altitude Sickness. BMJ Clinical Evidence, 2010, 1209.

[2]. The Cleveland Clinic. (2017). Altitude Sickness.

[3]. Barry, P.W. and Pollard, A.J. (2003). Altitude illness. The BMJ, 326(7395), 915-919.

[4]. Luks, A. (2018). Altitude Diseases. Merck Manual.

[5]. Leibenluft, J. (2008). Drunk and High in Denver. Slate.

[6]. Peng, Q. (2013). Physiological Responses and Evaluation of Effects of BMI, Smoking and Drinking in High Altitude Acclimatization: A Cohort Study in Chinese Han Young Males. PLoS One, 8(11), e79346.

[7]. Rose, B. (2013). Do You Really Get Drunker at High Altitude? Gizmodo.

[8]. Schommer, K. and Bartsch, P. (2011). Basic Medical Advice for Travelers to High Altitudes. Deutsches Arzteblatt, 108(49), 839-848.