Early recognition of the symptoms and signs is essential for the management of acute mountain sickness. If the symptoms and signs suggest the presence of mild to moderate acute mountain sickness, it is contraindicated to proceed to a higher sleeping altitude. A rest of at least 24 h should be taken during which the symptoms must be closely monitored. The aim of the treatment of severe acute mountain sickness and high-altitude cerebral edema is to improve the symptoms to the extent that a safe descent to low altitude (below 2500 m) is possible.
Treatment of mild to moderate acute mountain sickness
Mild to moderate acute mountain sickness can be treated by bed rest (BartscheLa/.: 1993) and/or acetazolamide. Acetazolamide is an inhibitor of carbonic anhydrase, which reduces the reabsorption of bicarbonate and sodium at the level of the renal tubules, leading to a metabolic acidosis within an hour of ingestion. An oral dose of acetazolamide 250 mg twice daily can be used for mild acute mountain sickness. Side-effects include peripheral paresthesias, polyuria, nausea, drowsiness, impotence, and myopia.
Treatment of severe acute mountain sickness and high-altitude cerebral edema
Severe acute mountain sickness and/or high-altitude cerebral edema should be treated with dexamethasone and bottled oxygen or a portable hyperbaric chamber if available. Dexamethasone is given at an initial dosage of 8 mg, followed by 4 mg every 6 h, and may provide longer-term clinical improvement than hyperbaric chamber treatment and more effective relief of the symptoms and signs of acute mountain sickness than acetazolamide (Hackettand Roach 1995.).
Treatment of acute mountain sickness by simulated descent
The portable hyperbaric chamber or Gamow bag has become popular in the treatment of acute mountain sickness (Hackettand Roach 1995; Ward eLaL 1995). (CD...
Figure 1) It is a lightweight (approximately 7 kg) fabric bag which is inflated by a manual air pump. At an altitude of 4559 m the treatment pressure of 193 mbar is equivalent to a descent of 2250 m, making the chamber an inexhaustible reserve of oxygen. However, studies have failed to show efficacy, and thus optimal treatment is simulated descent combined with dexamethasone.
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