Wilderness Medicine of Utah Newsletter

ACUTE
MOUNTAIN
SICKNESS

Its the season for ski trips. While working at a ski resort clinic at 8,500 feet you see a man complaining of headache, nausea and vomiting. He tells you that he arrived from the East Coast the night before and had dinner and a few drinks at the resort's lodge. Assuming he had some bad food or perhaps a few too many drinks, he asks you for some Tylenol so he can catch up with his friends on the slopes.

Why is it important to get a good history from this patient?
What treatment would you recommend for this patient?
How could this man prevent such sickness on future excursions?
How would the situation change if you were treating similar symptoms in a climber at Mt. McKinley Base Camp?

ANSWERS:
1. A good patient history is the key to accurate diagnosis with altitude conditions since acute mountain sickness has no special physiological signs to distinguish it from a myriad of other illnesses. Under normal circumstances, this mans self-diagnosis would probably be correct, but his rapid ascent should be a red flag.
2. Your patients will never like to hear this, but the most definitive treatment of acute mountain sickness is stopping ascent, rest and, best of all, descent. Some patients will respond well to an extra day of rest while others require descent perhaps to a hotel at a lower elevation. Acetazolamide and dexamethasone are also effective, but should not be a substitute for rest and ascent should only be continued 12-18 hours after the patient is symptom-free.
3. 125 mg Acetazolamide twice daily for a day or two before ascent can help those prone to AMS, but the proven prevention is graded ascent. Current recommendations are that an extra night of acclimatization should be added for every 300-900m of elevation gain, though more than 600m of sleeping elevation should be avoided. Alcohol consumption is highly discouraged when ascending.
4. Though contibuting factors and outcomes of AMS are unpredictable, a situation in which an AMS patient is still planning on significant elevation gains, the seriousness of the situation increases greatly. At increasing elevations, early AMS symptoms can develop quickly into pulmonary edema, which is immediately and seriously life thretening. In such situations, you should be absolutely sure that AMS symptoms have been resolved before ascent is continued.

One of the biggest problems with diagnosing altitude illnesses is that your patients will be reluctant to desist from their goal. In most cases, your patient has traveled and spent considerable amounts of money, time, and even physical preparation whether it be a week of skiing with friends or a Himalayan ascent. Don't be afraid to mandate rest or even descent, your patients will thank you for it.