Mountain Sickness Treatment

Self-Care at Home

• Delay further ascent until symptoms improve.
• Rest and stay warm.
• Take acetaminophen (Tylenol) for headache.
• Do not use sleeping pills or other central nervous system depressants to treat insomnia because they can suppress breathing.
• If symptoms continue, do not travel any higher.
• If symptoms worsen, descend approximately 1,000-2,000 feet (300-600 meters) immediately.
• If descent is not possible, a portable hyperbaric chamber (Gamow bag) can be used to simulate a lower altitude.
  • The higher the altitude at which a hyperbaric chamber is used, the greater the apparent descent can be simulated. (This is because portable hyperbaric chambers can increase atmospheric pressure by 2 pounds per square inch.)
  • For example, a hyperbaric chamber at 9,800 feet (3,000 meters) can simulate a descent of 4,800 feet (1,500 meters), but the same hyperbaric chamber used at 24,600 feet (7,500 meters) can simulate a descent of 7,800 feet (2,400 meters).

Medical Treatment

Descending to lower altitudes or delaying further ascent are treatments for AMS until symptoms are gone.

• A Gamow bag may be used if descent is not feasible.
• Oxygen (2-4 liters per minute) will improve oxygen saturation of blood.
• Aspirin or acetaminophen (Tylenol) may be taken for headache.
• For nausea, the doctor may prescribe prochlorperazine (Compazine), an antinausea medication that also enhances the body's ability to increase the breathing rate in response to low-oxygen environments.
• Sleeping pills for insomnia should not be taken. They are potentially dangerous because they can slow breathing.
• Acetazolamide (Diamox) may be prescribed to hasten acclimatization.
  • Acetazolamide is a diuretic (a drug that increases urine output) that increases kidney excretion of bicarbonate. This decreases the blood pH, thereby stimulating extra breathing, which results in higher oxygen levels in the blood.
  • In addition, acetazolamide corrects nighttime pauses in breathing known as periodic breathing. Acetazolamide also improves symptoms of insomnia.

HAPE responds best to descent.

• Oxygen, if available, should be provided.
• Nifedipine (Procardia), a medication for high blood pressure, has been shown to be beneficial for high altitude pulmonary edema (HAPE), a form of mountain sickness characterized by fluid in the lungs.
• Antibiotics may be given if a fever is present and pneumonia is possible.
• For more severe cases of HAPE, continuous positive airway pressure (CPAP) mask ventilation can be used. Although uncomfortable to wear, the CPAP mask helps by increasing the pressure of the inhaled air.
• If this intervention fails, a tube may be placed through the mouth and into the airway. This, along with assisted ventilation, is required to treat respiratory failure.

The only definitive treatment for high altitude cerebral edema (HACE), another form of mountain sickness characterized by brain swelling, is descent.

• Dexamethasone (Decadron, a steroid) may be beneficial.
  • Generally, if dexamethasone is considered, then a plan for descent should be in place unless descent is impossible.
  • Some people, after receiving dexamethasone, may feel so much better that they want to continue ascending. Under no circumstance should this be allowed.
• Oxygen may be helpful.
• A Gamow bag may buy time until descent is possible.

Anyone with HACE or HAPE should be kept as comfortable as possible.

• Exertion of any type should be minimized, even during descent.
• This means that it may be necessary to arrange descent for the ill person by whatever means available (helicopter, snowmobile, or mule, for example).