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Treating AMS

The mainstay of treatment of AMS is rest, fluids, and mild analgesics: acetaminophen (paracetamol), aspirin, or ibuprofen. These medications will not cover up worsening symptoms. The natural progression for AMS is to get better, and often simply resting at the altitude at which you became ill is adequate treatment. Improvement usually occurs in one or two days, but may take as long as three or four days. Descent is also an option, and recovery will be quite rapid.

A frequent question is how to tell if a headache is due to altitude. See Golden Rule I. Altitude headaches are usually nasty, persistent, and frequently there are other symptoms of AMS; they tend to be frontal (but may be anywhere), and may worsen with bending over. However, there are other causes of headaches, and you can try a simple diagnostic/therapeutic test. Dehydration is a common cause of headache at altitude. Drink one liter of fluid, and take some acetaminophen or one of the other analgesics listed above. If the headache resolves quickly and totally (and you have no other symptoms of AMS) it is very unlikely to have been due to AMS.

Acetazolamide (Diamox®)

Acetazolamide (Diamox®) is a medication that forces the kidneys to excrete bicarbonate, the base form of carbon dioxide; this re-acidifies the blood, balancing the effects of the hyperventilation that occurs at altitude in an attempt to get oxygen. This re-acidification acts as a respiratory stimulant, particularly at night, reducing or eliminating the periodic breathing pattern common at altitude. Its net effect is to accelerate acclimatization. Acetazolamide isn't a magic bullet, cure of AMS is not immediate. It makes a process that might normally take about 24-48 hours speed up to about 12-24 hours.

Acetazolamide is a sulfonamide medication, and persons allergic to sulfa medicines should not take it. Common side effects include numbness, tingling, or vibrating sensations in hands, feet, and lips. Also, taste alterations, and ringing in the ears. These go away when the medicine is stopped. Since acetazolamide works by forcing a bicarbonate diuresis, you will urinate more on this medication. Uncommon side effects include nausea and headache. A few trekkers have had extreme visual blurring after taking only one or two doses of acetazolamide; fortunately they recovered their normal vision in several days once the medicine was discontinued.

Acetazolamide Use & Dosage:

For treatment of AMS: We recommend a dosage of 250 mg every 12 hours. The medicine can be discontinued once symptoms resolve. Children may take 2.5 mg/kg body weight every 12 hours.

For Periodic Breathing: 125 mg about an hour before bedtime. The medicine should be continued until you are below the altitude where symptoms became bothersome.

There is a lot of mythology about acetazolamide:

MYTH: acetazolamide hides symptoms

Acetazolamide accelerates acclimatization. As acclimatization occurs, symptoms resolve, directly reflecting improving health. Acetazolamide does not cover up anything - if you are still sick, you will still have symptoms. If you feel well, you are well.

MYTH: acetazolamide will prevent AMS from worsening during ascent

Acetazolamide DOES NOT PROTECT AGAINST WORSENING AMS WITH CONTINUED ASCENT. It does not change Golden Rule II. Plenty of people have developed HAPE and HACE who believed this myth.

MYTH: acetazolamide will prevent AMS during rapid ascent

This is actually not a myth, but rather a misused partial truth. Acetazolamide does lessen the risk of AMS, that's why we recommend it for people on forced ascents. This protection is not absolute, however, and it is foolish to believe that a rapid ascent on acetazolamide is without serious risk. Even on acetazolamide, it is still possible to ascend so rapidly that when illness strikes, it may be sudden, severe, and possibly fatal.

MYTH: If acetazolamide is stopped, symptoms will worsen

There is no rebound effect. If acetazolamide is stopped, acclimatization slows down to your own intrinsic rate. If AMS is still present, it will take somewhat longer to resolve; if not - well, you don't need to accelerate acclimatization if you ARE acclimatized. You won't become ill simply by stopping acetazolamide.

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