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HWN Suggests

Don't die of altitude sickness

It is better to prevent acute mountain sickness than to try to treat it. Following the golden rules should mean that your body can acclimatise as you ascend and so you will be less likely to develop acute mountain sickness.

However, if you need to go up more quickly, you could consider taking a drug called acetazolamide (also known as Diamox). There is now good evidence that acetazolamide reduces symptoms of acute mountain sickness in trekkers, although it does have some unusual side-effects: it makes your hands and feet tingle, and it makes fizzy drinks taste funny.

As with any form of altitude sickness, if you do have acute mountain…

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 Prevention

Acetazolamide prophylaxis (125 mg PO q 12h): initiated one day prior to climbing and continued until acclimatization at the highest sleeping elevation. Gradual ascent – recommended that above 3000 m (9,842 ft) individuals increase their sleeping elevation no more than 300-500 m (984-1,640 ft) nightly.

Articles of Interest

Altitude, Acute Mountain Sickness and Headache

We now recognize that nearly one in four people who ascend to 2,600 meters (8,500 feet) above sea level develop symptoms referred to as acute mountain sickness (AMS). Headache is the most prominent symptom of AMS...

Efficacy and safety of inhaled budesonide on prevention of acute mountain sickness during emergent ascent: a meta-analysis of randomized controlled trials

Our systematic review showed that prophylactic inhaled budesonide is effective in preventing mild AMS during emergency ascent but not effective in preventing severe AMS.

Ibuprofen Could Ward Off Altitude Sickness, Study Finds

Ibuprofen has been used for decades to treat pain. Now, research suggests the drug's anti-inflammatory properties also may help prevent the piercing headaches and other symptoms of altitude sickness.

Ibuprofen for Acute Mountain Sickness?

While this study suggests that ibuprofen may be as effective as acetazolamide at prevention of AMS, it is already well established that the former treats headache. The LLQ uses headache as a primary diagnostic symptom and may therefore incorrectly overestimate the effectiveness of ibuprofen for prevention of AMS. Furthermore, this study was insufficient in its evaluation of prevention of the progression of HAPE or HACE as no cases of either were identified. It’s therefore impossible to draw any conclusions regarding the effect that ibuprofen may have at preventing progression to either of these two deadly entities.

Mountain Sickness

The best preventative measure is gradual ascent. Acetazolamide prophylaxis indicated in those who have previously experienced acute mountain sickness or anticipate a rapid ascent to altitude. Start 24 hours before ascent and continue until 48 hours after reaching final altitude. Dexamethasone can be started the day of ascent and likewise continued until the first two days at altitude. Ibuprofen also helps. Most often presents the 1st night or 2nd night at higher elevations. The average duration of symptoms in cases that self resolve is one day (the body successfully acclimates).

Recommended rates of ascent

There has been much debate in recent years over the recommended rates of ascent climbers and trekkers should employ to minimise the risk of suffering from Acute Mountain Sickness (AMS) or its more serious forms High Altitude Pulmonary Oedema (HAPE) and High Altitude Cerebral Oedema (HACE).

Resources

Core EM

Constellation of symptoms including headache with some combination of anorexia, nausea, nausea, dizziness, sleep disturbances, malaise caused by hypoxia at altitudes >2500 meters above sea level.

The Travel Doctor

Acute mountain sickness (AMS) is actually more common in fit young men because they are more likely to attempt a rapid ascent by racing up the mountain like some indestructible super hero! As a general rule, it is far safer (and more enjoyable) to avoid altitude sickness by planning a sensible itinerary that allows for gradual acclimatisation to altitude as you ascend, (you can race back down as fast as you like!).