Dexamethasone in the Treatment of Acute Mountain Sickness

Abstract

Cerebral edema occurs in fatal cases of acute mountain sickness. Dexamethasone, commonly used to treat cerebral edema due to other causes, also reduces the symptoms of acute mountain sickness when given prophylactically. However, the efficacy of dexamethasone in the treatment of established acute mountain sickness remains uncertain. To investigate this question, we exposed six men in a hypobaric chamber to a simulated altitude of 3700 m (barometric pressure, 64 kPa [481 mm Hg]) for 48 hours on two occasions. Acute mountain sickness was diagnosed with use of a symptoms questionnaire, and dexamethasone (4 mg every six hours) or placebo was then given in a randomized, double-blind, crossover fashion. Dexamethasone reduced the symptoms of acute mountain sickness by 63 percent (P less than 0.05), whereas placebo had a minimal effect (reduction by 23 percent; P not significant). In spite of this response, one subject had mild cerebral edema on brain CT after both placebo and dexamethasone. Dexamethasone had no effect on fluid shifts, oxygenation, sleep apnea, urinary catecholamine levels, the appearance of chest radiographs or perfusion scans, serum electrolyte levels, hematologic profiles, or the results of psychometric tests. Dexamethasone treatment was complicated by mild hyperglycemia in all subjects (mean [+/- SE] glucose level, 7.3 +/- 1.3 mmol per liter [132 +/- 23 mg per deciliter]). We conclude that dexamethasone effectively reduces the symptoms of acute mountain sickness. However, it did not improve objective physiologic abnormalities related to exposure to high altitudes. We therefore recommend that dexamethasone be used only when descent is impossible, or to facilitate cooperation in evacuation efforts.

Association of High-Altitude Pulmonary Edema With the Major Histocompatibility Complex

“…Moreover, dexamethasone, an effective immunosuppressive agent, has been successfully used to prevent and treat acute mountain sickness. 26 It is clear, at least, that HAPE occurs in relationship to both environmental and individual factors. The environmental factors are unique to high altitude and include hypoxia, hypobaria, and low temperatures.…”

Acute high-altitude sickness

“…Rehydration does not treat AMS per se, but does address any dehydration, the symptoms of which can mimic those of AMS. Acetazolamide [129] and dexamethasone [121,130] can be added for those individuals with more severe AMS symptoms or those who fail to respond to conservative measures. Individuals who remain ill despite several days of these conservative measures should descend 500-1000 m or until symptoms resolve.…”

Dexamethasone decreases migraine recurrence observed after treatment with a triptan combined with a nonsteroidal anti-inflammatory drug

“…However, the clinical experience demonstrates that some patients do continue to present with recurrence after successful treatment of their attacks, even with the combination of a triptan and a NSAID. In the other hand, steroids such as dexamethasone and prednisone have been suggested to treat refractory migraine, status migranosus and to terminate the nonresponsive headache cycle observed in rebound [10][11][12][13] .…”

“…Steroids have been suggested for the acute treatment of migraine attacks as well as to interrupt status migranosus 12,13,20 . Dexamethasone given intravenously at a dose of 6 mg following the administration of metoclopramide, was demonstrated to be effective in the treatment of a migraine attack 20 .…”