Altitude sickness medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

The classification of patients with acute mountain sickness as mild or moderate is based on the headache's severity and the presence of other manifestations such as nausea, dizziness, fatigue or insomnia.

The management of mild acute mountain sickness includes:

1. Discontinuation of ascent.
2. Treatment with acetazolamide (250 mg q12h).
3. Descent: The patient should descend below the point at which the symptoms occurred.

Similarly, the following steps are recommended for the management of moderate acute mountain sickness:

1. Immediate descent.
2. Administration of oxygen (2-4 L/min).
3. Treatment with dexamethasone (8 mg PO/IM/IV, then, 4 mg q6h).
4. Hyperbaric therapy: The patient is placed in a portable altitude chamber or bag.

Treatment of chronic mountain sickness involves descent from altitude, where the symptoms will diminish and the hematocrit will slowly return to normal. Acute treatment at altitude involves bleeding, or removing some circulating blood, to reduce the hematocrit; however this is not ideal for extended periods of time.

Treatment of high altitude cerebral edema (HACE) involves immediate descent as a necessary life-saving measure (2,000 - 4,000 feet). There are some medications (e.g. dexamethasone) that may be prescribed for treatment in the field, but these require proper medical training in their use. Anyone suffering from HACE must be evacuated to a medical facility for proper follow-up treatment. A Gamow bag can sometimes be used to stabilize the sufferer before transport or descending.

Medical Therapy

• Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

Disease Name

• Pharmacologic therapy of high altitude sickness include:
  • Preferred regimen (1): Acetazolamide 250 mg PO q12h
  • Preferred regimen (2): Dexamethasone 4 mg PO q6h

• Pharmacologic therapy for headache of altitude sickness include:
  • Preferred regimen (1): Acetaminophen 325-650 mg PO q4h PRN
  • Alternative regimen (2): Ibuprofen 200-400 mg q4-6h
  • Alternative regimen (3): Aspirin 325-650 mg PO q4-6h PRN

• Pharmacologic therapy for nausea and vomiting of altitude sickness include:
  • Preferred regimen (1): Promethazine 12.5-25 mg PO q4-6h PRN
  • Aletrantive regimen (2): Ondansetron 4mg PO q8h