Treatment Of Acute Mountain Sickness Research Articles

High altitude pulmonary edema after successful treatment of acute mountain sickness with dexamethasone

Case report A 28-year-old previously healthy male mountaineer with a history of radiologically documented HAPE participated in a study conducted in the high altitude research laboratory of the Capanna Margherita (4559 m) in the Alps Valais. The results of this study have been reported in detail elsewhere [8-10]. The subject had ascended from 1170 to 4559 m within a 24 h period, starting the ascent on foot at 3220 m and staying overnight at 3611 m. After the first night spent at 4559 m, he presented with severe AMS manifested by headache resistant to acetaminophen, nausea, insomnia, lassitude and dizziness. Clinical examination revealed facial edema, rales dorsally over the right middle lung field, no neurological abnormalities and normal fundoscopy. The severity of AMS was assessed by the environmental symptom questionnaire (ESQ) [11], which suggests a criterion score of > 0.70 for the subscore AMS-C reflecting cerebral symptoms and> 0.60 for the subscore AMS-R reflecting respiratory symptoms. The scores of AMS-C and AMS-R were 2.08 and 1.39, respectively, in this patient. The postero-anterior chest X-ray at this time showed no evidence of interstitial or alveolar pulmonary edema (Fig. lA). The patient was treated orally with 8 mg dexamethasone at 8 a.m. and 4 mg at 4 p.m. Thereafter, treatment was discontinued because of recovery from AMS symptoms in the evening with AMS-C and AMS-R scores of 0.68 and 0.44, respectively. At 6 a.m. on the following day, he presented with the same symptoms and clinical findings as 24 h previously, with scores of 2.46 (AMS-C) and 0.68 (AMS-R). The chest radiograph now

Dexamethasone in the treatment of acute mountain sickness: Levine B, Yoshimura K, Kobayashi T, et al N Engl J Med 321:1707–1713 Dec 21, 1989

Dexamethasone in the treatment of acute mountain sickness: Levine B, Yoshimura K, Kobayashi T, et al N Engl J Med 321:1707–1713 Dec 21, 1989

Acetazolamide Treatment of Acute Mountain Sickness

Acetazolamide Treatment of Acute Mountain Sickness

Medical therapy of altitude illness

Acute mountain sickness (AMS) and high-altitude pulmonary edema (HAPE) continue to cause significant morbidity and occasional deaths among mountain recreationists and residents. Descent to lower altitude is still considered the treatment of choice, but an increased role for medical therapy is emerging. Acetazolamide is currently the drug of choice for prevention of AMS, and probably HAPE as well. Numerous studies have demonstrated the drug's effectiveness when it is started 12 to 24 hours before ascent. Suggestions for indications, dosage, and regimen vary with different authors. Lower dosage offers adequate protection with fewer side effects. Acetazolamide has still not been adequately studied for treatment of altitude illness. Oxygen effectively treats HAPE and mild AMS, but is not as useful for cerebral edema. Dexamethasone recently was found effective for treatment of AMS, including early cerebral edema, but not for advanced cerebral edema. Side effects limit its use for prophylaxis, but dexamethasone offers an alternative to acetazolamide for those with sulfa intolerance.

Blood Coagulation Changes at High Altitude

The current concepts of blood coagulation changes in the pathogenesis of acute mountain sickness (AMS), high altitude pulmonary oedema (HAPO), high altitude pulmonary hypertension (HAPH) and chronic mountain sickness(CMS) which afflict the inductees and residents at high altitude have been reviewed. Hypercoagulable state which is more marked during the first few days of exposure is countered by enhanced fibrinolytic activity and accelerated cell mediated immunity. Magnesium levels are increased in normal residents at high altitudes and may be responsible for enhancing fibrinolytic activity and accelerating immune responses. Magnesium levels are significantly reduced in HAPO patients. Judicious use of furosemide in lower dosage is still the mainstay of treatment of HAPO and AMS.

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of Acute Mountain Sickness

To the Editor.— In a recent QUESTIONS AND ANSWERS (1983;249:1770), a question was raised concerning the prophylaxis of and therapy for highaltitude headache. I believe that Dr Dalessio's reply requires clarification and amplification. Headache occurring at high altitude is the most common manifestation of a broader constellation of symptoms, termed acute mountain sickness (AMS), that may include nausea, vomiting, anorexia, lassitude, and insomnia. Acute mountain sickness is the most common form of high-altitude illness, occurring to a variable extent in many sojourners higher than 2,400 m (8,000 ft), often after vigorous exercise or sleep at high altitude. Acetazolamide, a carbonic anhydrase inhibitor, has been shown to provide effective prophylaxis against the symptoms of AMS 1,2 but is not of proved therapeutic benefit in established AMS. A reasonable prophylactic regimen might be 250 mg every eight hours for 32 hours before and 40 hours after ascent. 1 The mechanism of benefit

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Non-smoking wives of heavy smokers have a higher risk of lung cancer

Non-smoking wives of heavy smokers have a higher risk of lung cancer H R Kornegay and M A Kastenbaum, phd; N Mantel; J E Harris, md, and W H DuMouchel, phd; Eleanor J Macdonald, md; T Hirayama, md. 914 Statistics in question M F Grayson, mrcp. 917 Caution on preventing neural tube defects V C Talwalkar, md. 917 The right to live and the right to die R B Zachary, frcs. 918 Microcomputers in antenatal care J R Davies, ffarcs. 918 Diving is dangerous for diabetics J D King, MB. 918 Dealing with epileptics Rachel Tavriger. 918 Management of asthma in the child aged under 6 years I Blumenthal, mrcp. 918 Minor orthopaedic problems in children A N Conner, frcsed, and J E Robb, frcsed 919 Reversible renal damage due to glue sniffing Mary D King, MB. 919 Audit in renal failure H J Goldsmith, frcp, and others. 919 Vitamin A toxicity and hypercalcaemia in chronic renal failure M O'Fearghail, MB, and others. 919 Treatment of acute mountain sickness P McDonald, frcs. 919 Proposals for a trial marriage between primary and secondary health care in one or two districts in inner London C J Dickinson, frcp. 920 Junior posts and expansion of the consultant grade A W Banks, frcog. 920 Changes in the MRCP examination M Ross, mrcp, and D M F Gibb, mrcp. .. 920 Will doctors miss out again? R C L Feneley, frcs. 920 Doctors' contracts: an urgent case for legislation J L Taylor, mrcgp ; F E Weale, frcs . Consultant contracts B A Kamdar, frcsed. New technique of drug promotion? J Iqbal, mrcgp. Corrections: Hypokalaemia due to sal butamol overdosage (Corea et al)', Deal? ing with epileptics (Beran and Sutton). .. 921 921

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness

Treatment of acute mountain sickness.

Treatment of acute mountain sickness.