What is the appropriate treatment for acute mountain sickness (AMS) due to a 14,000 feet altitude change?

From the Guidelines

The most effective treatment for altitude sickness at 14,000 feet is immediate descent to a lower altitude, which is the definitive intervention. If descent isn't immediately possible, supplemental oxygen at 2-4 liters per minute should be administered 1. For medication, acetazolamide (Diamox) at 125-250 mg twice daily can help accelerate acclimatization by increasing ventilation and reducing symptoms. Dexamethasone 4 mg every 6 hours can be used for severe symptoms, particularly cerebral edema. For symptomatic relief, ibuprofen (400-600 mg) or acetaminophen (650-1000 mg) every 6 hours can help with headache. Rest, hydration, and avoiding alcohol and sedatives are essential supportive measures. In severe cases with pulmonary edema, nifedipine 10 mg followed by 30 mg extended-release may be needed 1.

Key Considerations

• Prevention is always preferable through gradual ascent (no more than 1,000-1,500 feet per day above 8,000 feet), with rest days every 3,000 feet of elevation gain 1.
• High altitude retinopathy (HAR) is a spectrum of pathological changes that occurs in an individual who is exposed to a hypobaric hypoxic environment, and most cases resolve spontaneously and do not require intervention 1.
• Prophylactic medications, such as acetazolamide, can be effective, but individuals should be aware of potential side effects like a transient myopic shift and have proper corrective measures in place 1.

Treatment Options

• Immediate descent to a lower altitude is the most effective treatment for altitude sickness at 14,000 feet.
• Supplemental oxygen at 2-4 liters per minute should be administered if descent isn't immediately possible.
• Acetazolamide (Diamox) at 125-250 mg twice daily can help accelerate acclimatization.
• Dexamethasone 4 mg every 6 hours can be used for severe symptoms, particularly cerebral edema.
• Nifedipine 10 mg followed by 30 mg extended-release may be needed in severe cases with pulmonary edema.

From the Research

Treatment and Reversal of Altitude Sickness

For a difference of 14,000 feet, the treatment and reversal of altitude sickness are crucial to prevent significant morbidity and occasional deaths. The key considerations include:

• Descent to a lower altitude is still considered the treatment of choice 2
• Medical therapy, such as acetazolamide, can be effective in preventing and treating altitude sickness 2, 3
• Acetazolamide is the drug of choice for prevention of AMS, and probably HAPE as well, with a recommended dose of 500-750 mg/day within 24 hours of altitude exposure 3
• Oxygen therapy can effectively treat HAPE and mild AMS, but is not as useful for cerebral edema 2
• Dexamethasone can be effective for treatment of AMS, including early cerebral edema, but not for advanced cerebral edema 2

Prevention of Altitude Sickness

Prevention of altitude sickness is also crucial, and can be achieved through:

• Gradual ascent to allow for acclimatization 4, 5
• Pharmacologic methods, such as acetazolamide, dexamethasone, and nifedipine 4
• Risk stratification to determine whether to use pharmacologic prophylaxis 4
• Non-pharmacologic methods, such as decreasing sleep disturbance at high altitude and advising travelers on ascent to high altitude 4

Important Considerations

It is essential to note that:

• Acetazolamide may not be effective in preventing HAPE, despite reducing AMS severity and improving arterial oxygenation 6
• Rapid descent remains the most important treatment factor, although treatment at altitude with various therapies is possible for mild cases with adequate resources 5