Travel Reference
In-Depth Information
AMS, like all altitude illnesses, can lead to disordered thinking. Decisions may have to
be made for the individual, who may have to be forced to accept them. Problems have de-
veloped when persons—particularly trip leaders—have refused to accept the decision of a
medical professional. When the affected individual is a physician, problems may become
even worse.
Carbon monoxide combines preferentially with hemoglobin and displaces oxygen.
Using a stove in a small tent or an inadequately vented snow cave can lead to carbon
monoxide poisoning, which not only adds to altitude hypoxia but has caused a number of
deaths. This possibility must always be considered, even though the treatment—rapid des-
cent and oxygen—is the same as that for altitude illnesses.
IndividualswithAMSshouldavoidheavyexertion,althoughlightactivityisbetterthan
complete rest.Sleep isnothelpful because respirations areslowerduringsleep, whichmay
make symptoms worse. Sedatives, including alcohol, should be avoided at night since they
also decrease respiration. Low-flow oxygen at night is very helpful.
Affected persons should drink adequate fluids and eat a light, high-carbohydrate diet.
Acetaminophen or ibuprofen is helpful for headache. Tobacco and alcohol should be
avoided.
Acetazolamide,forwhichaprescriptionisrequired,canhelptopreventAMSandspeed
acclimatization. The dose recommended by most authorities is 125 mg twice daily, begin-
ning one day before ascent and continuing for two days after arrival. If 125 mg tablets are
not available; the correct dosage can be achieved by breaking 250 mg tablets in half. Ex-
tended release capsules, which come in a 500 mg size, are also effective. The dose is one
capsule daily, which is twice the currently recommended dose, but because of slower re-
lease, the side effects are less than would be expected.
Tingling in the lips, fingers, or toes is a common side effect. Carbonated beverages (in-
cluding beer) taste flat because the drug affects taste buds, and urine volume is increased.
These symptoms subside when the drug is stopped. Because acetazolamide is chemically
related to sulfa drugs, rare individuals sensitive to sulfa may not be able to take it. Some
individuals are more sensitive to sunlight while taking it.
Anothermedication,dexamethasone,canalsobeusedfortreatingAMS,butunlikeacet-
azolamide it masks symptoms, does not speed acclimatization, and has more side effects,
including emotional changes of euphoria and depression after stopping. Rebound acute
mountain sickness can occur when dexamethasone is stopped after ascent to high altitude.
The most effective treatment for AMS after it has developed is descent. Mild AMS
can be safely treated by waiting for acclimatization to occur. This generally takes two to
four days, although rare individuals take longer to acclimatize, and a few continue to have
symptoms of AMS for an indefinite period. Acetazolamide is also helpful for treatment
and works by speeding acclimatization. Tylenol or ibuprofen can be given for headaches,
and any anti-nausea medicine may relieve the nausea. Prochlorperizine (Compazine® in
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