From the Guidelines
Acute Mountain Sickness (AMS) in pediatric patients is primarily prevented by proper acclimatization, gradual ascent, staying hydrated, and avoiding alcohol and smoking, with prophylactic medications like acetazolamide being effective but requiring awareness of potential side effects. The management of AMS in pediatric patients should focus on prompt recognition of symptoms, which can include headache, nausea, vomiting, and fatigue, and immediate action to reduce altitude exposure and improve oxygenation. According to 1, high altitude retinopathy (HAR) is a potential complication of high-altitude travel, and while it is often asymptomatic and resolves spontaneously, it may require intervention with supplemental oxygen and descent to a lower altitude in severe cases.
Causes of AMS
- Hypobaric hypoxia due to high altitude
- Rapid ascent without proper acclimatization
- Dehydration
- Underlying cardiac or respiratory conditions
- Physical exertion before acclimatization
Management of AMS
- Gradual ascent with rest days to allow for acclimatization is crucial, as recommended by 1 and 1
- Staying hydrated and avoiding alcohol and smoking
- Prophylactic medications like acetazolamide, with awareness of potential side effects like transient myopic shift
- Immediate descent to a lower altitude and administration of supplemental oxygen if symptoms of AMS or HAPE appear
- Consideration of alternative prophylactic medications like nifedipine, PDE5 inhibitors, or dexamethasone for patients with a history of HAPE, as suggested by 1
Diagnostic Workup
- Assessment of symptoms and medical history
- Physical examination, including vital signs and neurological assessment
- Laboratory tests, such as complete blood count and blood chemistry, as indicated
- Consideration of neuroimaging or other diagnostic tests if symptoms persist or worsen
Consultation and Referral
- Early consultation with pediatric neurology and critical care is essential for optimal management of pediatric AMS
- Referral to a specialist or a higher level of care if symptoms are severe or worsening despite treatment.
From the Research
Causes of Acute Mountain Sickness (AMS) in Pediatric Patients
- AMS occurs in non-acclimatized people after an acute ascent to an altitude of 2,500 m or higher 2
- The incidence of AMS varies individually and geographically, with factors such as altitude headache, ataxia, and sudden loss of strength being essential for diagnosis 3
- In pediatric patients, the overall incidence of AMS was found to be 40.6%, with males and individuals with a higher body mass index (BMI) being at higher risk 2
Management of Acute Mountain Sickness (AMS) in Pediatric Patients
- Rest, descent or evacuation, and warmth are the main emergency measures for AMS 3
- Additional therapeutic measures such as oxygen, portable hyperbaric chamber, ibuprofen/naproxen, nifedipine, and dexamethasone can be helpful if evacuation to lower altitudes is delayed 3, 4, 5
- Acetazolamide is effective in preventing AMS, but its use as an emergency therapy is not recommended 3, 4, 5
- Dexamethasone is effective in treating severe AMS, including early cerebral edema, but not for advanced cerebral edema 4, 5
- Descent to lower altitude is still considered the treatment of choice, but medical therapy is also emerging as an important role in management 5, 6
Symptoms of Acute Mountain Sickness (AMS) in Pediatric Patients
- The most common symptoms of AMS in pediatric patients are sleep disturbance, dizziness, and headache 2
- Males experience significantly more headache and fatigue than females 2
- The prevalence of headache was found to be 46.2% on Day 2 at 3,100 m, and 31.3% on Day 3 at the same altitude after climbing the summit (3,886 m) 2