Prevention and Treatment of Acute Altitude Illness
Publication Date: June 1, 2019
Last Updated: March 14, 2022
Recommendations
Acute mountain sickness (AMS) and high altitude cerebral edema (HACE)
PREVENTION
Gradual ascent, defined as a slow increase in sleeping elevation, is recommended for AMS and HACE prevention. A specific approach is described further later in the text. (1 – Strong, B)
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Acetazolamide
Acetazolamide should be strongly considered in travelers at moderate or high risk of AMS with ascent to high altitude. ( 1 – Strong , A)
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Acetazolamide can be used in children for prevention of AMS. (1 – Strong, C)
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Dexamethasone
Dexamethasone can be used as an alternative to acetazolamide for adult travelers at moderate or high risk of AMS. (1 – Strong, A)
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Inhaled budesonide
Inhaled budesonide should not be used for altitude illness prophylaxis. (1 – Strong, C)
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Ginkgo biloba
Ginkgo biloba should not be used for AMS prevention. (1 – Strong, C)
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Ibuprofen
Ibuprofen can be used for AMS prevention in persons who do not wish to take acetazolamide or dexamethasone or have allergies or intolerance to these medications. (2 – Weak, B)
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Acetaminophen
Acetaminophen should not be used for AMS prevention. (1 – Strong, C)
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Staged ascent and preacclimatization
When feasible, staged ascent and preacclimatization can be considered as a means for AMS prevention. (1 – Strong, C)
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Hypoxic tents
Hypoxic tents can be used for facilitating acclimatization and preventing AMS, provided sufficiently long exposures can be undertaken regularly over an appropriate number of weeks and other factors, such as sleep quality, are not compromised. (2 – Weak, B)
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TREATMENT
Descent
Descent is effective for any degree of AMS/HACE and is indicated for individuals with severe AMS, AMS that fails to resolve with other measures, or HACE. (1 – Strong, A)
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Supplemental oxygen
When available, ongoing supplemental oxygen sufficient to raise SpO2 to >90% or to relieve symptoms can be used while waiting to initiate descent or when descent is not practical. (1 – Strong, A)
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Portable hyperbaric chambers
When available, portable hyperbaric chambers should be used for patients with severe AMS or HACE when descent is infeasible or delayed and supplemental oxygen is not available. (1 – Strong, B)
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Acetazolamide
Acetazolamide should be considered for treatment of AMS. (1 – Strong, C)
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Dexamethasone
Dexamethasone should be considered for treatment of AMS. (1 – Strong, B)
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Dexamethasone should be administered to patients with HACE. (1 – Strong, B)
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Acetaminophen
Acetaminophen can be used to treat headache at high altitude. (1 – Strong, C)
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Ibuprofen
Ibuprofen can be used to treat headache at high altitude. (1 – Strong, C)
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Continuous positive airway pressure
Because of lack of data, no recommendation can be made regarding use of CPAP for AMS treatment. (, U)
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High altitude pulmonary edema (HAPE)
PREVENTION
Gradual ascent
Gradual ascent is recommended to prevent HAPE. (1 – Strong, B)
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Nifedipine
Nifedipine is recommended for HAPE prevention in HAPE-susceptible people. (1 – Strong, B)
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Salmeterol
Salmeterol is not recommended for HAPE prevention. (2 – Weak, B)
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Tadalafil
Tadalafil can be used for HAPE prevention in known susceptible individuals who are not candidates for nifedipine. (1 – Strong, C)
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Dexamethasone
Dexamethasone can be used for HAPE prevention in known susceptible individuals who are not candidates for nifedipine and tadalafil.
(1 – Strong, C)679
Acetazolamide
Because of lack of data, no recommendation can be made regarding use of acetazolamide for HAPE prevention. (, U)
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Acetazolamide can be considered for prevention of reentry HAPE in people with a history of the disorder. (1 – Strong, C)
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Preacclimatization and staged ascent
When feasible, staged ascent and preacclimatization can be considered as a means for HAPE prevention. (1 – Strong, C)
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TREATMENT
Descent
Descent is indicated for individuals with HAPE. (1 – Strong, A)
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Supplemental oxygen
When available, supplemental oxygen sufficient achieve an SpO2 of >90% or to relieve symptoms should be used while waiting to initiate descent when descent is infeasible and during descent in severely ill patients. (1 – Strong, A)
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Portable hyperbaric chambers
When descent is infeasible or delayed or supplemental oxygen is unavailable, a portable hyperbaric chamber may be used to treat HAPE. (1 – Strong, C)
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Nifedipine
Nifedipine should be used for HAPE treatment when descent is impossible or delayed and reliable access to supplemental oxygen or portable hyperbaric therapy is unavailable. (1 – Strong, C)
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Beta-agonists
No recommendation can be made regarding beta-agonists for HAPE treatment due to lack of data. (, U)
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Phosphodiesterase inhibitors
Tadalafil or sildenafil can be used for HAPE treatment when descent is impossible or delayed, access to supplemental oxygen or portable hyperbaric therapy is impossible, and nifedipine is unavailable. (2 – Weak, C)
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Continuous positive airway pressure
CPAP or EPAP may be considered for treatment of HAPE when supplemental oxygen or pulmonary vasodilators are not available or as adjunctive therapy in patients not responding to supplemental oxygen alone. (2 – Weak, C)
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Diuretics
Diuretics should not be used for treatment of HAPE. (1 – Strong, C)
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Acetazolamide
Acetazolamide should not be used for treatment of HAPE. (1 – Strong, C)
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Dexamethasone
Because of insufficient evidence, no recommendation can be made regarding dexamethasone for HAPE treatment. (, U)
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Recommendation Grading
Overview
Title
Prevention and Treatment of Acute Altitude Illness
Authoring Organization
Wilderness Medical Society
Publication Month/Year
June 1, 2019
Last Updated Month/Year
January 30, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Athletics coaching, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D000532 - Altitude Sickness
Keywords
dexamethasone, high altitude, Acute Altitude Illness, Acute Mountain Sickness, High altitude pulmonary edema, high altitude cerebral edema, acetazolamide, nifedipine