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The goal of the study was to characterize high altitude illness in Nepali pilgrims.We kept standardized records at the Himalayan Rescue Association (HRA) Temporary Health Camp at Gosainkund Lake (4380 m) in the Nepal Himalaya during the annual Janai Purnima Festival in 2014. Records included rate of ascent and Lake Louise Score (LLS). We defined High Altitude Headache (HAH) as headache alone or LLS = 2. Acute Mountain Sickness (AMS) was LLS≥3. High Altitude Cerebral Edema (HACE) was AMS with ataxia or altered mental status.An estimated 10,000 pilgrims ascended rapidly, most in 1-2 days, from Dhunche (1960 m) to Gosainkund Lake (4380 m). We saw 769 patients, of whom 86 had HAH. There were 226 patients with AMS, including 11 patients with HACE. We treated patients with HACE using dexamethasone and supplemental oxygen prior to rapid descent. Each patient with HACE descended carried by a porter. There were no fatalities due to HACE. There were no cases of High Altitude Pulmonary Edema (HAPE).HAH and AMS were common in pilgrims ascending rapidly to 4380 m. There were 11 cases of HACE, treated with dexamethasone, supplemental oxygen and descent. There were no fatalities.

Original publication




Journal article


Travel medicine and infectious disease

Publication Date





31 - 34


Department of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA, USA; Himalayan Rescue Association, Kathmandu, Nepal. Electronic address:


Humans, Brain Edema, Acute Disease, Altitude Sickness, Oxygen, Dexamethasone, Altitude, Holidays, Adult, Nepal, Female, Male