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foreste Sep 21st, 2017 02:38

Death by Altitude...

I have some questions about AMS in Spiti. I have a BIG fear about developing HAPE or HACE and death by altitude sickness while in Kaza/Spiti... to the point where I wonder if I should even go (even though I really want to).

I want to know if my fears are irrational or if it's actually a common thing that could really happen... and how likely?

Here's the route I will take:

Manali (2 nights to acclimatize somewhat) then on to Kaza directly (note: I understand it's better to go via Shimla to acclimatize slowly, but this is not an option). I will being taking Diamox, will eat carbohydrates and stay hydrated.

Manali= 2,050 m
Kaza= 3,800 m
Tabo= 3,280 m

Would it make much difference to continue on and stay overnight at Tabo rather than Kaza?

If you do experience serious symptoms- how can you descend rapidly? Where is there to go?

If you were go to the hospital or health centre, what would they do? And is there such a place in Tabo- or just Kaza?

Has anyone ever died, just from being in Kaza or the area (in the village and not even trekking)? How common is it? Ever hear of it happening?

Thank you, I look forward to any information, suggestions, advice, experiences, thoughts.

kmalik Sep 21st, 2017 02:51

The nights are Manali are worthless as far as acclimatization are concerned. So, leave them out of your calculations. And, it is definitely not safe to proceed to 3800m elevation.

One night at Tabo is a minimum but might not be sufficient. Try to spend two nights at Tabo - may be hike a bit to a higher elevation on those days but return to sleep at Tabo .

The guidelines are that after roughly 3000m - the sleeping altitude should not increase by much more 300m on consecutive nights - and after two 300m increases, you need one extra night at the same elevation. So, I am recommending two nights at 3200m with an acclimatization hike on one of the days before raising the sleeping elevation by 600m.

There will be various posts listing how so and so has done is without problems. They are not going to help you if you do have a problem. I suggest you stay somewhere in the range of the guidelines.

vaibhav_arora Sep 21st, 2017 03:00

Kalpa is the perfect place for acclimatization on the Spiti circuit when coming from Shimla side. When coming from Manali, the distance is a bit much but Tabo is the same altitude and would work well. I do not recommend staying in Kaza coming from lower altitudes - I had some shortness of breath even after spending two nights in Tabo, so I would suggest not to be overambitious on this trip. You can look at my TR in signature for some idea about these places.

RahulDeva Sep 21st, 2017 11:45

A few questions, what is your age and fitness levels? It helps if you are young and fit. Also diamox is a great help if started 48 hours before the altitude gain. I have no idea about the places but from recent experience of leh via manali by motorcycle, I think that a reasonable fitness level along with diamox and one night at a medium altitude say 9-10000 feet will work fine. My fitness is dicey but I started walking 3-4 kms daily in the fortnight prior to leaving. And I could spend my second night at sarchu without any problem. Hope this helps

8thFrog Sep 21st, 2017 15:02


Originally Posted by foreste (Post 2057707)
Has anyone ever died, just from being in Kaza or the area (in the village and not even trekking)?

Dude are you seriously serious? I mean if you are an otherwise healthy person with no previous history of heart ailments or no history of asthmatic disorders, are you seriously serious?

Nick-H Sep 21st, 2017 16:43


Dude are you seriously serious?
I used to sail. Get a group of friends together and charter a yacht for a week or two at a time, a couple of times a year. Two or three of us would have experience, two or three would be novices. We would have a pre-trip get-together/briefing, part of this would be an attempt to ensure that people took water extremely seriously, including a simple list of dos and don'ts.

Once, somebody asked me, "seriously, what are the chances of sinking?"

When in doubt... it's better to ask. :D

theyyamdancer Sep 21st, 2017 17:21

Fitness levels and/or age have absolutely no bearing on whether someone is susceptible or not to Altitude Mountain Sickness.

8thFrog Sep 21st, 2017 19:56


Originally Posted by Nick-H (Post 2057779)
Once, somebody asked me, "seriously, what are the chances of sinking?"

When in doubt... it's better to ask. :D

True, I agree. But the probability of dying by AMS while not trekking in Kaza is lesser than me trying to build a rocket from scratch that will do a successful landing on Moon. :D
Or for that matter even lesser than the chances of sinking while not yachting.

The only doubt I had while visiting Kaza was if I would be able to get a good snap of the milky way. [Blush]

kmalik Sep 21st, 2017 20:19

I don't know the probability involved but the guidelines are unequivocal and contrary to what you are saying. To proceed to 3800 m without some acclimatization (min of 2 days at an altitude like Tabo) is well outside of the guidelines. And, one's health plays a very small role. The statistics of altitude sickness is skewed towards the younger and presumably healthier people - likely precisely because of the bravado leading them to risk it more often.

One is, of course, free to free to play Russian roulette with one's own life. But, to suggest it to others who are asking a serious question is something different. The guidelines are derived from statistics - and the individual experience based / anecdotal sample size is way too small to draw valid inferences.

PS: And, Dimox does not absolve one from following the guidelines.

Some useful reading -

8thFrog Sep 21st, 2017 20:50


Originally Posted by kmalik (Post 2057808)
One is, of course, free to free to play Russian roulette with one's own life. But, to suggest it to others who are asking a serious question is something different. The guidelines are derived from statistics - and the individual experience based / anecdotal sample size is way too small to draw valid inferences.

Sure my friend, I acknowledge the statistics and guidelines. But don't people fly directly to Leh (3,500m) and acclimatize there for a couple of days? Kaza is only 300 more meters higher than Leh. I am sure people would have done the same if there was an airport in Kaza.

And, I never suggested anything to the OP here. I just asked him if he was serious.

kmalik Sep 21st, 2017 21:37

  • People do have altitude sickness issues in Leh.
  • 3500 m is generally considered the transition point between high altitude and very high altitude zones.
  • "...only 300 more meters" requires an extra night of stay according to the generally accepted guidelines.

The OP's query was serious and your response not.

RahulDeva Sep 21st, 2017 21:44

Ok. Point taken. Thats why I have said I think. This worked for our group of 4 different people each time in gangotri as well as laddakh. I am no specialist , what I speak is from experience only. In fact among our friends There is a couple with desk jobs who flew to leh from mumbai {sea level} and next day visited turtuk after spending half an hour at khardungla. And they did not face any trouble at all. But that I won't suggest to anyone,ever.

kmalik Sep 21st, 2017 21:57

Thank you!

As I said earlier, the problem with anecdotal evidence is that the sample sizes are too small. The death rates from in Nepal trekking were found to be something like 15/100,000. A lot of people are afflicted but fewer die. But, that's hardly invitation to take a higher risk. Also read the link from Independent I included above...

aarosh Sep 21st, 2017 23:42

How do you plan to travel to Kaza from Manali? Instead of spending 2 nights in Manali, may be you could stay a night in Manali / Solang Valley and the other in either Gramphu or Batal.

NonIndianResident Sep 24th, 2017 15:36

After many years of experience in Ladakh and seeing many people arrive by air or road, I still don't have any hard data, but I can tell you these experiences.
-- Spiti is generally similar altitudes to Ladakh, so I think it is relevant.

-- Fitness has little or no relation to whether people get basic altitude sickness (AMS). I've seen some very fit people get altitude sickness, and I've seen many many unfit people (including myself) who never got any problem. And vice-versa. Fitness seems to be unrelated to risk of altitude sickness.

-- I've met or known thousands of people who flew into Leh. I've known dozens who got AMS (headache and maybe vomiting). I've never actually known anyone who died from it.

-- A few dozen people die from the altitude in Leh every year (especially since Indian tourism started in 2011). The numbers are tiny, but they do actually happen. Yes, seriously.

-- The biggest risks seems to be when people arrive and quickly proceed higher, crossing high passes toward Pangong Lake or Nubra, without stopping to acclimatise fully in Leh first for a few days.

-- Aside from normal AMS (a headache and maybe vomiting), I've known a few who probably had HACE because they had splitting headaches and even reduced consciousness. I have only met one visitor who may have had HAPE: her lungs were making a weird sound when you put your ear to her chest. I've known two people who had terrifying (but harmless) episodes of hyperventilating here. I've known three people who got unexpectedly high blood pressure on arrival in Ladakh, including one Ladakhi, one part time resident who had come here 30 times over 30 years, and one 22 year old fit European kid. I know one Ladakhi who loses chunks of his hair as long as he's in Ladakh, but grows luxurious locks when he spends time down in Delhi, and he once had an episode where he visited a high altitude border area of Ladakh and went unconscious overnight, was kept alive by mouth-to-mouth respiration by a companion while they drove him over a pass and down the other side (he stopped breathing on his own at the top); he felt much better when they got lower, and was basically fine when they reached Leh.

The risk is low numbers but real.

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