Acute Mountain Sickness and Acetazolamide

Larson, Eric B.; Roach, Robert C.; Schoene, Robert B.; Hornbein, Thomas F.

doi:10.1001/jama.1982.03330030034021

Cited by 141 publications

(26 citation statements)

References 17 publications

(2 reference statements)

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“…As expected, acetazolamide offered a protective effect against AMS. In a double-blind placebo study, Larson and colleagues 32 showed that acetazolamide users had fewer and less severe symptoms of AMS during a rapid, active ascent of Mt Rainier (4394 m). Since that time, many other researchers have demonstrated that acetazolamide is an effective prophylactic against AMS, and it is the recommended drug treatment to prevent this condition.…”

Section: Altitude History and Physical Conditioningmentioning

confidence: 99%

Variables Contributing to Acute Mountain Sickness on the Summit of Mt Whitney☆

Wagner

Fargo

Parker

et al. 2006

Wilderness & Environmental Medicine

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Objective.-The interaction of 15 variables representing physical characteristics, previous altitude exposure, and ascent data was analyzed to determine their contribution to acute mountain sickness (AMS).Methods.-Questionnaires were obtained from 359 volunteers upon reaching the summit of Mt Whitney (4419 m). Heart rate and arterial oxygen saturation were measured with a pulse oximeter, and AMS was identified by Lake Louise Self-Assessment scoring. Multiple logistic regression analysis was used to identify significant protective and risk factors for AMS.Results.-Thirty-three percent of the sample met the criteria for AMS. The odds of experiencing AMS were greater for those who reported a previous altitude illness (adjusted odds ratio [OR] ϭ 2.00, P Ͻ .01) or who were taking analgesics during the ascent (adjusted OR ϭ 2.09, P Ͻ .01). Odds for AMS decreased with increasing age (adjusted OR ϭ 0.82, P Ͻ .0001), a greater number of climbs above 3000 m in the past month (adjusted OR ϭ 0.92, P Ͻ .05), and use of acetazolamide during the ascent (adjusted OR ϭ 0.33, P Ͻ .05).Conclusions.-The significant determinants of AMS on the summit of Mt Whitney were age, a history of altitude illness, number of climbs above 3000 m in the past month, and use of acetazolamide and analgesics during ascent.

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Section: Altitude History and Physical Conditioningmentioning

confidence: 99%

Variables Contributing to Acute Mountain Sickness on the Summit of Mt Whitney☆

Wagner

Fargo

Parker

et al. 2006

Wilderness & Environmental Medicine

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“…The most eective way to prevent AMS is to ascend gradually and to become acclimatizated to high altitude. Drugs such as Dexamethasone (Hackett et al 1988) and Acetazolamide (Greene et al 1981, Larson et al 1982 have been used to prevent AMS, but have not been found to be universally eective (Larson et al 1982) and they have been observed to have unpleasant side eects (Greene et al 1981). Consequently, other methods of preventing AMS without drugs have been studied (BaÈ rtsch 1992).…”

Section: Introductionmentioning

confidence: 99%

Positive end expiratory pressure as a method for preventing acute mountain sickness

Savourey

Caterini

Launay

et al. 1997

European Journal of Applied Physiology

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In order to study the use of positive end expiratory pressure (PEEP) to prevent acute mountain sickness (AMS), 22 subjects were exposed randomly to 8-h hypobaric hypoxia in a hypobaric chamber (4500 m, 589 hPa, 22 degrees C) once being administered 5-cm H2O PEEP and once without. The prevention of AMS by PEEP was evaluated by scoring AMS according to the Lake Louise system (self-report questionnaire and clinical assessment) throughout the experiment with O2 saturation (SO2) and heart rate measurements being made. Arterial blood analyses (partial pressures of arterial O2 and CO2, PaO2, PaCO2, and pH) were made at the end of the exposure. Results showed decreased AMS scores with PEEP at the end of the 8-h hypoxia [1.50 (SEM 1.32) vs 3.23 (SEM 2.07), P < 0.01 for self-report plus clinical assessment scores] with a lower prevalence (23% vs 55%, P < 0.01). The SO2, PaO2, PaCO2 and HCO3- did not change significantly. However, a smaller increase in arterial pH [7.47 (SEM 0.02) vs 7.50 (SEM 0.02), P < 0.05] was observed with PEEP, attesting a lesser alkalosis. Moreover, heart rate increased with PEEP (P < 0.05). In conclusion, this study would suggest that a 5-cm H2O PEEP may help decrease AMS scores at the end of an 8-h exposure to hypoxia in a hypobaric chamber. Such a method could be used to prevent AMS in such experimental conditions without adverse effects.

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“…Several studies have demonstrated the efficacy of acetazolamide at a dose of 250 mg, two to three times daily, in the prevention of acute mountain sickness (Gray et al, 1971;Larson et al, 1982;Zell and Goodman, 1988;Ellsworth et al, 1991). Of note, these studies were all performed on vigorously exercising subjects, typically climbers ascending mountain peaks.…”

mentioning

confidence: 99%

A Dose–Response Study of Acetazolamide for Acute Mountain Sickness Prophylaxis in Vacationing Tourists at 12,000 Feet (3630 m)

Carlsten

Swenson

Ruoss

2004

High Altitude Medicine & Biology

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The study objective was to determine whether acetazolamide is effective in prophylaxis of acute mountain sickness (AMS) at moderate altitude in ambulatory travelers not undergoing vigorous exercise. Volunteers vacationing in La Paz, Bolivia (3630 m), immediately after arrival from sea level were studied. The design was a double-blind, randomized trial of two doses of acetazolamide (125 mg twice daily, 250 mg twice daily) versus placebo twice daily over a 24-h period. The main outcome measure was AMS score and score trend, using the Lake Louise consensus questionnaire. Nine of 32 subjects (28%) had symptom scoring diagnostic of AMS at 0 h. At 0 and 24 h (respectively), the mean Lake Louise scores were 1.73 and 1.09 for the 11 subjects receiving placebo, 1.45 and 1.36 for the 11 subjects receiving the 125-mg dose, and 2.7 and 0.6 for the 11 subjects receiving the 250-mg dose. The absolute change in these mean scores was not significant for placebo (p = 0.21) or the 125-mg dose (p = 0.88), but was significant for the 250-mg dose (p = 0.008). A comparison of a difference in decline in average AMS score over time showed a statistically significant decline for the 250-mg dosing group versus placebo (p = 0.002). The 250-mg dose of acetazolamide twice daily (but not 125 mg twice daily) was effective in inducing a significant decline in AMS symptoms over the 24-h period after arrival to 3630 m. These results suggest that the dosing of acetazolamide for AMS prevention in nonmountaineering tourists at altitudes below 3700 m should not be lowered below 250 mg twice daily.

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Acute Mountain Sickness and Acetazolamide

Cited by 141 publications

References 17 publications

Variables Contributing to Acute Mountain Sickness on the Summit of Mt Whitney☆

Variables Contributing to Acute Mountain Sickness on the Summit of Mt Whitney☆

Positive end expiratory pressure as a method for preventing acute mountain sickness

A Dose–Response Study of Acetazolamide for Acute Mountain Sickness Prophylaxis in Vacationing Tourists at 12,000 Feet (3630 m)

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