Advertisement

Prophylaxis and Treatment of Acute Mountain Sickness

Summary

Acute mountain sickness (AMS) can be avoided in most circumstances by “slow ascent”, which includes not increasing the sleeping altitude above 2500 m by more than 300 m per 24 h. Care should also be taken to ensure an adequate fluid intake. Warning signs of AMS, such as headache, lassitude, insomnia, nausea, cough, peripheral and periorbital edemas and dyspnea on exertion should be respected and lead to rest days. Travelers who tend to become sick in spite of these prophylactic measures can take acetazolamide as prophylaxis, usually in a dose of 500 mg once a day. The efficacy of dexamethasone in the prophylaxis of AMS has also been demonstrated. Inefficient or dangerous medications include antacids, iron and vitamin preparations, phenytoin, potassium supplements, furosemide and medroxyprogesterone.

Mild cases of AMS can be treated with rest days and symptomatic medications. Severely affected patients should descend, be evacuated to a lower altitude or , if this is impossible, be treated with oxygen. If this is not available, dexamethasone 8 mg initially followed by 4 mg every 6 h alleviates the severity of AMS. This treatment should be reserved for emergencies to facilitate safe descent and is generally more effective for cerebral symptoms than for the pulmonary manifestations of AMS.

Keywords

Acute Mountain Sickness Periodic Breathing Hypoxic Ventilatory Response Expiratory Positive Airway Pressure Aviat Space Environ 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bärtsch P, Waber U, Haeberli A, Maggiorini M, Kriemler S, Oelz P, Straub WP (1987) Enhanced fibrin formation in high altitude pulmonary edema. J Appl Physiol 63:752–757PubMedGoogle Scholar
  2. 2.
    Bradwell AR, Coote JH, Milles JJ, Dykes PW, Forster PJE, Chesner I, Richardson NV (1986) Effect of acetazolamide on exercise performance and muscle mass at high altitude. Lancet 1:1001–1005PubMedCrossRefGoogle Scholar
  3. 3.
    Cain SM, Dunn JE II (1966) Low doses of acetazolamide to aid accommodation of men to altitude. J Appl Physiol 21:1195–1200PubMedGoogle Scholar
  4. 4.
    Ellsworth AJ, Larson EB, Strickland D (1987) A randomized trial of dexametha-sone and acetazolamide for acute mountain sickness prophylaxis. Am J Med 83:1024–1030PubMedCrossRefGoogle Scholar
  5. 5.
    Ferrazzini G, Maggiorini M, Kriemler S, Bartsch P, Oelz O (1987) Successful treatment of acute mountain sickness with dexamethasone. Br Med J 294:1380–1382CrossRefGoogle Scholar
  6. 6.
    Forwand SA, Landowne M, Follansbee JN, Hansen JE (1968) Effect of acetazolamide on acute mountain sickness. N Engl J Med 279:839–845PubMedCrossRefGoogle Scholar
  7. 7.
    Greene MK, Kerr AM, Mcintosh IB, Prescott RJ (1981) Acetazolamide in prevention of acute mountain sickness: a double-blind controlled cross-over study. Br Med J 283:811–813CrossRefGoogle Scholar
  8. 8.
    Hackett PH (1980) Mountain sickness. Prevention, recognition and treatment. Am Alpine ClubGoogle Scholar
  9. 9.
    Hackett PH, Rennie D (1979) Rales, peripheral edema, retinal hemorrhage and acute mountain sickness. Am J Med 67:214–218PubMedCrossRefGoogle Scholar
  10. 10.
    Hackett PH, Roach RC (1987) Medical therapy of altitude illness. Ann Emerg Med 16:980–986PubMedCrossRefGoogle Scholar
  11. 11.
    Hackett PH, Rennie D, Levine HD (1976) The incidence, importance, and prophylaxis of acute mountain sickness. Lancet 11:1149–1154CrossRefGoogle Scholar
  12. 12.
    Hackett PH, Roach RC, Harrison GL, Schoene RB, Mills WJ Jr (1987) Respiratory stimulants and sleep periodic breathing at high altitude. Almitrine versus acetazolamide. Am Rev Respir Dis 135:896–898PubMedGoogle Scholar
  13. 13.
    Hochstrasser J, Nanzer A, Oelz O (1986) Das Hohenodem in den Schweizer Alpen. Beobachtungen uber Inzidenz, Klinik und Verlauf bei 50 Patienten der Jahre 1980— 1984. Schweiz Med Wochenschr 116:866–873PubMedGoogle Scholar
  14. 14.
    Johnson TS, Rock PB, Fulco CS, Trad LA, Spark RF, Maher JT (1984) Prevention of acute mountain sickness by dexamethasone. N Engl J Med 310:683–686PubMedCrossRefGoogle Scholar
  15. 15.
    Kryger M, Glas R, Jackson D, McCullough RE, Scoggin C, Grover RF, Weil JV (1978) Impaired oxygenation during sleep in excessive polycythemia of high altitude: improvement with respiratory stimulation. Sleep 1:3–17PubMedGoogle Scholar
  16. 16.
    Larson EB (1985) Positive airway pressure for high-altitude pulmonary oedema. Lancet 1:371–373PubMedCrossRefGoogle Scholar
  17. 17.
    Larson EB, Roach RC, Schoene RB, Hornbein TF (1982) Acute mountain sickness and acetazolamide. Clinical efficacy and effect on ventilation. JAMA 248:328–332PubMedCrossRefGoogle Scholar
  18. 18.
    Maggiorini M, Buhler B, Walter M, Oelz O (1986) Inzidenz und Erscheinungsfor-men der akuten Bergkrankheit in den Schweizer Hochalpen. Schweiz Med Wochenschr [Suppl 20]116:24Google Scholar
  19. 19.
    Oelz O (1983) High altitude cerebral oedema after positive airway pressure breathing at high altitude. Lancet 11:1148CrossRefGoogle Scholar
  20. 20.
    Oelz O (1985) Prophylaxe und Therapie der akuten Bergkrankheit. Ther Umsch 42:52–57PubMedGoogle Scholar
  21. 21.
    Oelz O (1987) A case of high-altitude pulmonary edema treated with nifedipine. JAMA 257:780PubMedCrossRefGoogle Scholar
  22. 22.
    Roach RC, Larson EB, Hornbein TF, Houston CS, Bartlett S, Hardesty J, Johnson D, Perkins M (1983) Acute mountain sickness, antacids, and ventilation during rapid, active ascent of Mount Rainier. Aviat Space Environ Med 54:397–401PubMedGoogle Scholar
  23. 23.
    Rock PB, Johson TS, Cymerman A, Burse RL, Falk LJ, Fulco CS (1987) Effect of dexamethasone on symptoms of acute mountain sickness at Pikes peak, Colorado (4300 m). Aviat Space Environ Med 58:668–672PubMedGoogle Scholar
  24. 24.
    Schoene RB, Roach RC, Hackett PH, Harrison G, Mills WJ Jr (1985) High altitude pulmonary edema and exercise at 4400 m on Mount McKinley. Effect of expiratory positive airway pressure. Chest 87:330–333PubMedCrossRefGoogle Scholar
  25. 25.
    Sutton JR, Houston CS, Mansell AL, McFadden MD, Hackett PM, Rigg JRA, Powles ACP (1979) Effect of acetazolamide on hypoxemia during sleep at high altitude. N Engl J Med 301:1329–1331PubMedCrossRefGoogle Scholar
  26. 26.
    Wohns RNW, Colpitts M, Clement T, Karuza A, Blackett WB, Foutch R, Larson E (1986) Phenytoin and acute mountain sickness on Mount Everest. Am J Med 80:32–36PubMedCrossRefGoogle Scholar
  27. 27.
    Wright AD, Bradwell AR, Fletcher RF (1983) Methazolamide and acetazolamide in acute mountain sickness. Aviat Space Environ Med 54:619–621PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • O. Oelz

There are no affiliations available

Personalised recommendations