Doctors raced to attend to the thousands of injured who flooded hospitals. Many had to be treated in makeshift areas set up in tents or parking lots.
As supplies ran out, hospitals scrambled to get medicines.
Rescue operations are under way throughout the mountainous kingdom. Nepal's neighbors, including India and Pakistan, sent condolences and were scrambling to provide assistance.
Saturday's earthquake was the strongest in 81 years in Nepal, since an even mightier jolt in 1934 that killed more than 10,000 people.
The massive scale of the tragedy unfolded in the hours after the earthquake flattened homes, damaged buildings, and split open walls and roads in the bustling Kathmandu Valley - home to 2.5 million people and Nepal’s main cities. Historic structures made of wood and unmortared brick were leveled.
Aid workers warned that the situation could be far worse near the epicenter.
The U.S. Geological Survey said the quake was centered near Lamjung, about 80 kilometers (50 miles) northwest of Kathmandu, in the Gorkha district.
Roads to that area were blocked by landslides, hindering rescue teams, chief district official Prakash Subedi told AP.
Teams were trekking through mountain trails to reach remote villages, and helicopters would also be deployed, he said by telephone.
The aid group World Vision said in a statement that remote mountain communities, including in Gorkha, were totally unprepared for the level of destruction caused by the earthquake.
The earthquake also triggered an avalanche at the Mount Everest Base Camp, killing several guides and mountaineers and flattening many tents. Romanian climber Alex Gavan tweeted, “Running for life from my tent.” Thousands of foreign nationals were reported to be in Nepal for the spring trekking season.
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