Nepal's health ministry has published a national standard for managing high-altitude sickness. It covers prevention, treatment, rescue and what health posts need to stock, and it gives ascent figures of 300–500 m a night above 2,500 m. Here is what it says, what it does not change for trekkers, and how our routes measure up.

Nepal's New Altitude Sickness Standard: What It Says and What It Changes for Trekkers

Nepal's Ministry of Health and Food Safety has approved a national standard for managing high-altitude sickness. The Department of Health Services published it on 6 November 2026 (20 Kartik 2083), and Nepali and English outlets reported it the same day. Its title is The Standard Related to Management of High-Altitude Mountain Sickness, 2083, where 2083 is the Bikram Sambat year. The Himalayan Times calls it the country's first national standard for the condition.

It is a health-system document. It tells hospitals, health posts and the three levels of government how to prevent, diagnose and treat altitude illness, what equipment and medicines to hold, and who is responsible for what. In the text we read, it places no obligations on trekkers, guides or trekking companies, and it does not change permits, insurance requirements or itineraries. What it does add is a set of ascent and rest-night figures in an official Nepali document. We read the original, compared the figures with CDC guidance, and checked two of our own routes against them. The results are below.

The Standard at a Glance

Question	Answer
Official title	The Standard Related to Management of High-Altitude Mountain Sickness, 2083 (Bikram Sambat)
Issued by	Ministry of Health and Food Safety, through the Department of Health Services (Curative Services Division)
Published	6 November 2026 (20 Kartik 2083)
Legal basis	Section 64 of the Public Health Service Act, 2075 (Bikram Sambat)
Aimed at	Health institutions in high hill and Himalayan areas, and federal, provincial and local governments
Covers	Prevention, symptoms, treatment, medicines and equipment, evacuation and referral, responsibilities by level of government
Obligations for trekkers or operators	None found in the text we read

What the Standard Sets Out to Do

The document lists four objectives:

Awareness and prevention
Health-facility preparedness and supply management
Effective treatment and management
Emergency evacuation and referral

The Himalayan Times and Nepal's national news agency, RSS, say it covers tourists, trekkers, mountaineers and local residents, and that its main aim is to detect altitude illness early and make sure people get the right treatment. Most of the detail concerns health institutions in high hill and Himalayan areas: their treatment capacity, their supplies and their emergency rescue and referral arrangements.

What It Says About Prevention

This is the part trekkers will recognize. These are the points as we read them in the Nepali text:

Go up gradually. After passing 2,500 m, give your body time to adjust, and do not go more than 300–500 m higher than the previous night's altitude.
Climb high, sleep low. Walk to a higher point in the daytime, then come back down to sleep.
Schedule rest days. After every 1,000 m of ascent, stay two nights at that place.
Drink plenty. At least 3 to 4 liters a day of water, hot liquids, lemon-and-honey water or soup.
Eat carbohydrates. Rice, dal, potatoes, flatbread.
Avoid alcohol and tobacco. The text says they lower oxygen levels further and dehydrate you.
Do not go higher with symptoms, and tell your companions if you feel unwell.

What It Says About Treatment and Rescue

The standard sorts altitude illness into three conditions and gives a short decision path for each:

Acute mountain sickness (AMS). Symptoms usually appear within 8 to 48 hours of ascending: headache, dizziness, nausea, vomiting, loss of appetite, heavy tiredness, weakness, poor sleep and shortness of breath. The path is rest, acetazolamide and no further ascent.
High-altitude pulmonary edema (HAPE), fluid in the lungs. Trouble breathing even at rest, a heavy chest, a persistent cough that may bring up blood or froth, bluish skin and weakness. The path is oxygen, nifedipine and descent.
High-altitude cerebral edema (HACE), brain swelling. Severe headache, loss of balance, slurred speech, confusion and, in the worst case, loss of consciousness. The path is dexamethasone, a portable hyperbaric chamber (Gamow bag) and immediate evacuation.

Descent is described as the most effective treatment: if resting does not reduce symptoms, the patient should go down at once. The scanned copy we read does not show the descent distance clearly, so we do not quote one. Oxygen and the Gamow bag are to be used where available. The document lists doses for clinicians. We do not repeat them, because a news article is not a prescription. For symptoms and what to do on the trail, use our altitude sickness guide.

What Health Facilities Are Meant to Hold

For health institutions in high hill and Himalayan areas, the standard lists:

Equipment: oxygen cylinders or concentrators, a hyperbaric chamber or Gamow bag, pulse oximeter, blood pressure set, stethoscope, thermometer, nebulizer and ECG machine.
Medicines: acetazolamide, dexamethasone, nifedipine SR, PDE-5 inhibitors (sildenafil or tadalafil), painkillers, anti-nausea drugs, salbutamol for the nebulizer, and oral rehydration salts and IV fluids.
General emergency supplies: an airway and resuscitation kit, wound and trauma supplies, hypothermia wraps and heat packs, cold-resistant lithium batteries, solar power and backup generators, light stretchers and satellite communication.
An emergency medicines list covering injectable and oral drugs, from hydrocortisone and adrenaline to morphine and iloprost, along with IV sets, syringes and catheters.

Who Is Responsible for What

Level	Responsibilities in the standard
Federal government	Policy, standards and regulation, human resources, budget, and regular monitoring and feedback
Provincial governments	Training and capacity-building for health workers, technical support and monitoring
Local governments	Access to designated and emergency health services, buying and distributing medicines and supplies, budget as needed, a referral system, and records and reports to the federal and provincial levels

What It Means for Trekkers

Nothing changes at the permit counter. The text we read sets no requirement for trekkers, guides or companies: no mandatory rest days, no ascent cap you can be fined for, no new insurance rule. Permit and insurance conditions are set elsewhere, and we found nothing in this document that alters them.

The numbers are now official. Clinics, operators and the press are likely to quote 300–500 m a night and two nights per 1,000 m. They sit close to what the CDC says, and now they are in a government document, with provincial governments responsible for training health workers.

Better-equipped health posts may take time. A standard says what should be in place. It does not say when each health post will have an oxygen concentrator or a Gamow bag, and the reports we read give no timeline or budget figure. Do not plan a trek around a health post having the kit. Plan around your guide's equipment, your insurance and your own judgment.

Rescue and referral should improve, slowly. Referral is assigned to local governments, and satellite communication and light stretchers are on the equipment list. That helps in the villages along the trail. It does not shorten the time to a road or a helicopter, which is why insurance that covers helicopter evacuation stays essential. Our Manaslu insurance and evacuation guide explains what to look for in a policy.

Descent comes first. The standard puts descent at the front of treatment and says not to go higher once symptoms appear. That matches the rule our guides already follow: no one ascends with symptoms.

How Our Routes Compare With the Figures

We checked two of our standard schedules against the Nepali figures, using the sleeping altitudes on our own pages. The text gives 300–500 m, so we measure each step against the upper figure, 500 m.

Route	Night	Step from the night before	Against 500 m
Manaslu Circuit, 12 days	Namrung, 2,630 m	+770 m	Ends 130 m above the 2,500 m line
Manaslu Circuit, 12 days	Shyala, 3,500 m	+870 m	370 m over
Manaslu Circuit, 12 days	Dharamsala, 4,460 m	+585 m	85 m over
Short Manaslu Circuit, 10 days	Samagaun, 3,530 m	+900 m	400 m over
Short Manaslu Circuit, 10 days	Dharamsala, 4,460 m	+930 m	430 m over
Everest Base Camp	Namche Bazaar, 3,440 m	+830 m (from Phakding, 2,610 m)	330 m over
Everest Base Camp	Dingboche, 4,410 m	+550 m (from Tengboche, 3,860 m)	50 m over
Everest Base Camp	Lobuche, 4,910 m	+500 m	At the figure

Manaslu figures come from our Manaslu Circuit altitude guide, and Everest figures from our Everest Base Camp elevation guide.

On both routes, at least one step is above 500 m, and that is the honest reading. The villages sit where they sit, and many Himalayan itineraries have to take an occasional large step. What a good schedule does is pair each large step with something that softens it. On the 12-day Manaslu route, the +870 m step to Shyala is followed by a +30 m night at Samagaun and then a rest night, and the +585 m step to Dharamsala is followed by the pass crossing and a night 732 m lower at Bhimthang. On Everest, Namche and Dingboche each have a rest day. On the 10-day Manaslu route the same climbs arrive as single nights of +900 m and +930 m, close to double the upper figure. That is the trade for saving two days.

The standard does not call any of this a breach. It is a prevention guideline in a health-sector document, not a rule for operators. We show the arithmetic because you can check it, and because on the two routes above, Nepal's own figure is tighter than the schedule. A schedule is a mitigation, not an exemption, and it does not change how your body responds. If you have never slept above 3,500 m, choose the longer schedule and ask about an extra night. On a private trip we can add acclimatization nights or change the pace; tell us the highest place you have slept before and how you felt there.

For the full night-by-night tables, see the altitude guides for Manaslu, Gokyo Lakes, the Everest Three Passes, Mardi Himal and Thorong La.

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What to Do Before Your Next High-Altitude Trek

Ask for the sleeping altitude of every night above 2,500 m, not only the day's highest point. Any operator should be able to give it to you.
Find the steps above 500 m and see what follows each one: a small gain, a descent or a rest night.
Count the rest nights and see where they fall in relation to the biggest climbs.
Plan to drink 3 to 4 liters a day and to skip alcohol and tobacco, as the standard says.
Agree with your guide before you start that nobody climbs higher with symptoms, and who makes the call at each decision point.
Check your insurance covers the highest altitude on your route and helicopter evacuation.

Our Manaslu altitude guide has a longer version of this checklist, how to read any itinerary, that works for any route.

Trek With Places Nepal

Our fixed departures follow the published itinerary on each trip page, where current dates and group pricing are listed. Group pricing applies to two or more people. See the Everest Base Camp Trek, the Manaslu Circuit Trek and the Annapurna Circuit Trek. If you want a slower pace, extra acclimatization nights or a different start date, a private customized trip can be built around your altitude history. Tell us about your plans and we will suggest a schedule.

What We Still Do Not Know

Timing and funding. The reports give no date by which health posts will be equipped and no budget figure.
Some figures in the scanned copy. The descent distance and some dose digits are not legible in the copy we read. The original is on the Department of Health Services website, in Nepali.
An English version. We did not find one.
Wider adoption. Whether trekking regulators or guide-training bodies will adopt the same figures. Nothing we read says so.

Frequently Asked Questions About Nepal's Altitude Sickness Standard

What is Nepal's new altitude sickness standard? It is The Standard Related to Management of High-Altitude Mountain Sickness, 2083, a ministry standard issued under Section 64 of the Public Health Service Act, 2075. It covers prevention, diagnosis, treatment, medicines and equipment, evacuation and referral, and sets responsibilities for federal, provincial and local governments. The Department of Health Services published it on 6 November 2026.

Does the standard apply to trekkers or trekking companies? Not directly. It is written for the health system. In the text we read, it sets no requirements for trekkers, guides or trekking companies. Its prevention advice (go up gradually, rest, drink water, do not climb with symptoms) is guidance for everyone traveling at altitude.

What ascent rate does the standard recommend? After passing 2,500 m, no more than 300–500 m above the previous night's altitude, with two nights at a place after every 1,000 m of ascent, and "climb high, sleep low." We read the 300–500 m figure as a limit on sleeping altitude.

How does it compare with CDC guidance? The CDC sets a ceiling of 500 m a night in sleeping altitude once above 3,000 m, with an extra night for every 1,000 m gained. Nepal's standard begins at 2,500 m and gives a 300–500 m range. The table above sets them out side by side.

Will health posts on the Everest, Annapurna and Manaslu routes now have oxygen and Gamow bags? The standard says health institutions in high hill and Himalayan areas need them. It does not say when each post will have them, and we found no timeline in the reports. Plan on the equipment your guide carries and on insurance that covers evacuation.

Does this change permits, insurance or trek length? Nothing in the text we read does. Permits, insurance conditions and itineraries are set elsewhere, and each operator builds its own schedule.

Is it the "2083 standard" or the "2026 standard"? It is the same document. 2083 is the Bikram Sambat year, which runs from April 2026 to April 2027. Online Khabar's English report labels it 2026. The official title uses 2083.

Where can I read the original? On the Department of Health Services page. The document is in Nepali with English headings, and it is a scanned copy.

The Bottom Line

Nepal now has a national standard for altitude sickness, and it is aimed at hospitals and health posts, not at trekkers. For you, the useful part is the prevention section: above 2,500 m, no more than 300–500 m higher than the previous night, two nights after every 1,000 m climbed, climb high and sleep low, drink 3 to 4 liters a day, and do not go higher with symptoms. Those figures sit close to the CDC's, and they are a reasonable yardstick for any itinerary, ours included. The standard does not make the mountains safer by itself. Equipped health posts will help over time, and the decisions that matter on the trail are still yours and your guide's.

This article is general information, not medical advice. Altitude affects people unpredictably, whatever their age, fitness or experience. Talk to a doctor who knows high-altitude travel before you go, make sure your insurance covers your route's highest altitude and helicopter evacuation, and follow your guide's decisions on the trail. We read the standard from a scanned Nepali copy and have left out any figure we could not read clearly.