Duration Health

Altitude Illness

Introduction

Altitude illness is a spectrum of conditions that are common in travelers at high altitude (above 2,500 meters/8,000 feet). Altitude illnesses include acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). Altitude illness can range from mild to life-threatening.

Symptoms of AMS include: mild to moderate headache, nausea, poor appetite, fatigue, sleep disturbances, and mild dizziness. HAPE causes a productive cough and shortness of breath. HACE causes severe headache, severe dizziness, an unsteady gait, nausea and vomiting, confusion, and changes in mental status.

While mild AMS can be managed with medications and slowing your ascent, severe AMS, HAPE, and HACE are medical emergencies. If you notice any shortness of breath, confusion, severe headache, severe nausea and vomiting, or an unsteady gait, you should descend to a lower elevation and seek medical attention immediately.

Treatment

Acute Mountain Sickness (AMS)

For prevention of AMS and treatment of mild to moderate AMS, consider acetaZOLAMIDE (generic for Diamox). For severe AMS, consider adding dexamethasone and immediately descend to a lower altitude and seek medical care.

High Altitude Pulmonary Edema (HAPE)

For HAPE, consider starting NIFEdipine and dexamethasone. Immediately descend to a lower altitude and seek emergency medical attention.

High Altitude Cerebral Edema (HACE)

For HACE, consider acetaZOLAMIDE and dexamethasone. Immediately descend to a lower altitude and seek emergency medical attention.

Quick Guide

For prevention of

Acute Mountain Sickness (AMS)

Consider using

acetaZOLAMIDE 125 mg twice a day starting 24 hours before ascent and until 2 days after arrival at your highest altitude

If you have

  • mild to moderate headache
  • mild nausea/vomiting
  • difficult sleeping
  • fatigue
  • mild dizziness

You may have

Acute Mountain Sickness (AMS)

Consider using

acetaZOLAMIDE 250 mg twice a day

OR

Pediatrics

For children age 17 and under

acetaZOLAMIDE 2.5 mg/kg/dose twice daily for 10 days (maximum dose 125 mg)

For example, a child weighing 15 kg (33 lbs) would receive 37.5 mg (equal to 15 times 2.5) in the morning and another 37.5 mg at night, for a total of 75 mg in a 24 hour period.

See also: Pediatrics

If you have

  • shortness of breath at rest
  • a productive cough

You may have

High Altitude Pulmonary Edema (HAPE)

Consider using

NIFEdipine 20 mg every 8 hours

AND

Descend to a lower altitude and seek emergency medical care

OR

Pediatrics

For children age 17 and under

nifedipine should not be used in children for altitude illness unless recommended by a treating physician

See also: Pediatrics

If you have

  • severe headache
  • nausea or vomiting
  • confusion
  • severe dizziness
  • unsteady gait

You may have

High Altitude Cerebral Edema (HACE)

Consider using

dexamethasone 4 mg every 8 hours

AND

acetaZOLAMIDE 250 mg twice a day

AND

descend to a lower altitude and seek emergency medical care

OR

Pediatrics

For children age 17 and under

dexamethasone should not be used in children for altitude illness unless recommended by a treating physician

See also: Pediatrics

Reference

Dexamethasone (generic for Decadron) is a steroid used to treat a wide variety of inflammatory conditions including croup, asthma and allergy. It is also used to prevent and treat acute mountain sickness. This medication should be taken with food. In the context of acute mountain sickness, recommendations are to carry dexamethasone for extended excursions above 3k-4k meters (10,000-12,000 feet). This medication is taken at the first sign of high altitude cerebral edema (HACE), a life-threatening form of altitude sickness, as an adjunct to the definitive treatment: immediate descent. HACE is characterized by unsteady gait (ataxia), confusion, stupor, and other severe neurologic signs. HACE can be thought of as a severe form of the more common Acute Mountain Sickness (AMS), which presents as something closer to a hangover.

Prescription only

WildernessMedication

Acetazolamide is a diuretic is used to prevent and treat acute mountain sickness.

Prescription only

WildernessMedication

Nifedipine is a blood pressure medication that can be used in emergency circumstances to treat high altitude pulmonary edema (HAPE). Oxygen and descent are the most important treatments for HAPE. However, if oxygen and descent are difficult or impossible, nifedpine may be a useful adjunct treatment.

Prescription only

WildernessMedication

Sildenafil may be used in emergency circumstances to treat high altitude pulmonary edema (HAPE). It works by opening up the blood vessels in the lungs (pulmonary vasodilation). While this medication is included here because of its emergency use in altitude illness, it is best known for its use as a treatment for erectile dysfunction, under the brand name Viagra.

Prescription only

WildernessMedication

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