What is the treatment for altitude sickness?

Treatment for Altitude Illness

The most effective treatment for altitude sickness is immediate descent to lower altitude, supplemented with oxygen therapy to maintain SpO₂ >90%, and appropriate medications based on the specific type and severity of altitude illness. 1

Types of Altitude Illness

Altitude illness typically presents in three main forms:

1. Acute Mountain Sickness (AMS) - Mild to moderate symptoms
2. High-Altitude Cerebral Edema (HACE) - Severe cerebral form
3. High-Altitude Pulmonary Edema (HAPE) - Severe pulmonary form

Treatment Algorithm

For Mild to Moderate AMS:

• Stop ascent and rest at current altitude 1, 2
• Maintain adequate hydration
• Medications:
  • Acetazolamide (125-250mg every 12 hours) 1, 3
  • Analgesics for headache (acetaminophen/ibuprofen)
• Monitor for worsening symptoms

For Severe AMS or HACE:

• Immediate descent (minimum 300m) - this is the definitive treatment 1, 4
• Supplemental oxygen to maintain SpO₂ >90% 1
• Medications:
  • Dexamethasone (8mg initially, then 4mg every 6 hours) 1, 4
  • Continue acetazolamide if already started
• Consider portable hyperbaric chamber if descent is not immediately possible 2

For HAPE:

• Immediate descent (minimum 300m) 1
• Supplemental oxygen to maintain SpO₂ >90% 1
• Minimize exertion - consider stretcher evacuation if available 2
• Medications:
  • Nifedipine (30mg extended-release every 12 hours or 10mg immediate-release every 4 hours) 1, 3
  • PDE-5 inhibitors (sildenafil, tadalafil) as alternatives 1
  • Consider dexamethasone if HACE is also suspected

Special Considerations

• Physical rest is crucial for all forms of altitude illness 2
• Portable hyperbaric chambers can provide temporary relief when immediate descent is not possible 2
• Expiratory positive airway pressure (EPAP) may improve oxygenation in HAPE cases 2
• Never delay descent in a patient with worsening symptoms 5

Prevention Strategies

• Gradual ascent (<400m/day above 2,500m) with rest days every 600-1,200m gained 1
• Pre-acclimatization when possible (2+ weeks with >8h/day at progressively increasing altitudes) 1
• Prophylactic medications:
  • Acetazolamide (125mg twice daily) starting 1 day before ascent and continuing for 2 days at maximum altitude 1, 6
  • Nifedipine for HAPE-susceptible individuals 1, 3

Warning Signs Requiring Immediate Descent

• Ataxia or altered mental status
• Severe headache unrelieved by analgesics
• Shortness of breath at rest
• Decreased consciousness
• Cough with pink frothy sputum

The American Heart Association and American College of Cardiology emphasize that while medications can help manage symptoms, they should never replace descent when symptoms are severe or worsening 1.