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. 1991 Mar;154(3):289–293.

Acetazolamide or dexamethasone use versus placebo to prevent acute mountain sickness on Mount Rainier.

A J Ellsworth 1, E F Meyer 1, E B Larson 1
PMCID: PMC1002747  PMID: 2028586

Abstract

Eighteen climbers actively ascended Mount Rainier (elevation 4,392 m) twice during a randomized, double-blind, concurrent, placebo-controlled, crossover trial comparing the use of acetazolamide, 250 mg, dexamethasone, 4 mg, and placebo every 8 hours as prophylaxis for acute mountain sickness. Each subject was randomly assigned to receive placebo during one ascent and one of the active medications during the other ascent. Assessment of acute mountain sickness was performed using the Environmental Symptoms Questionnaire and a clinical interview. At the summit or high point attained above base camp, the use of dexamethasone significantly reduced the incidence of acute mountain sickness and the severity of symptoms. Cerebral and respiratory symptom severity scores for subjects receiving dexamethasone (0.26 +/- 0.16 and 0.20 +/- 0.19, respectively) were significantly lower than similar scores for both acetazolamide (0.80 +/- 0.80 and 1.20 +/- 1.05; P = 0.25) and placebo (1.11 +/- 1.02 and 1.45 +/- 1.27; P = .025). Neither the use of dexamethasone nor that of acetazolamide measurably affected other physical or mental aspects. Compared with placebo, dexamethasone appears to be effective for prophylaxis of symptoms associated with acute mountain sickness accompanying rapid ascent. The precise role of dexamethasone for the prophylaxis of acute mountain sickness is not known, but it can be considered for persons without contraindications who are intolerant of acetazolamide, for whom acetazolamide is ineffective, or who must make forced, rapid ascent to high altitude for a short period of time with a guaranteed retreat route.

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Selected References

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  1. Cain S. M., Dunn J. E., 2nd Low doses of acetazolamide to aid accommodation of men to altitude. J Appl Physiol. 1966 Jul;21(4):1195–1200. doi: 10.1152/jappl.1966.21.4.1195. [DOI] [PubMed] [Google Scholar]
  2. Ellsworth A. J., Larson E. B., Strickland D. A randomized trial of dexamethasone and acetazolamide for acute mountain sickness prophylaxis. Am J Med. 1987 Dec;83(6):1024–1030. doi: 10.1016/0002-9343(87)90937-5. [DOI] [PubMed] [Google Scholar]
  3. Evans W. O., Robinson S. M., Horstman D. H., Jackson R. E., Weiskopf R. B. Amelioration of the symptoms of acute mountain sickness by staging and acetazolamide. Aviat Space Environ Med. 1976 May;47(5):512–516. [PubMed] [Google Scholar]
  4. Fishman R. A. Brain edema. N Engl J Med. 1975 Oct 2;293(14):706–711. doi: 10.1056/NEJM197510022931407. [DOI] [PubMed] [Google Scholar]
  5. Forwand S. A., Landowne M., Follansbee J. N., Hansen J. E. Effect of acetazolamide on acute mountain sickness. N Engl J Med. 1968 Oct 17;279(16):839–845. doi: 10.1056/NEJM196810172791601. [DOI] [PubMed] [Google Scholar]
  6. Gray G. W., Bryan A. C., Frayser R., Houston C. S., Rennie I. D. Control of acute mountain sickness. Aerosp Med. 1971 Jan;42(1):81–84. [PubMed] [Google Scholar]
  7. Greene M. K., Kerr A. M., McIntosh I. B., Prescott R. J. Acetazolamide in prevention of acute mountain sickness: a double-blind controlled cross-over study. Br Med J (Clin Res Ed) 1981 Sep 26;283(6295):811–813. doi: 10.1136/bmj.283.6295.811. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gutin P. H. Corticosteroid therapy in patients with cerebral tumors: benefits, mechanisms, problems, practicalities. Semin Oncol. 1975 Mar;2(1):49–56. [PubMed] [Google Scholar]
  9. Hackett P. H., Rennie D., Levine H. D. The incidence, importance, and prophylaxis of acute mountain sickness. Lancet. 1976 Nov 27;2(7996):1149–1155. doi: 10.1016/s0140-6736(76)91677-9. [DOI] [PubMed] [Google Scholar]
  10. Hackett P. H., Rennie D. Rales, peripheral edema, retinal hemorrhage and acute mountain sickness. Am J Med. 1979 Aug;67(2):214–218. doi: 10.1016/0002-9343(79)90393-0. [DOI] [PubMed] [Google Scholar]
  11. Hackett P. H., Roach R. C. Medical therapy of altitude illness. Ann Emerg Med. 1987 Sep;16(9):980–986. doi: 10.1016/s0196-0644(87)80744-8. [DOI] [PubMed] [Google Scholar]
  12. Hackett P. H., Roach R. C., Wood R. A., Foutch R. G., Meehan R. T., Rennie D., Mills W. J., Jr Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med. 1988 Oct;59(10):950–954. [PubMed] [Google Scholar]
  13. Hamilton A. J., Cymmerman A., Black P. M. High altitude cerebral edema. Neurosurgery. 1986 Nov;19(5):841–849. doi: 10.1227/00006123-198611000-00024. [DOI] [PubMed] [Google Scholar]
  14. Houston C. S. High altitude illness. Disease with protean manifestations. JAMA. 1976 Nov 8;236(19):2193–2195. [PubMed] [Google Scholar]
  15. Johnson T. S., Rock P. B. Current concepts. Acute mountain sickness. N Engl J Med. 1988 Sep 29;319(13):841–845. doi: 10.1056/NEJM198809293191306. [DOI] [PubMed] [Google Scholar]
  16. Johnson T. S., Rock P. B., Fulco C. S., Trad L. A., Spark R. F., Maher J. T. Prevention of acute mountain sickness by dexamethasone. N Engl J Med. 1984 Mar 15;310(11):683–686. doi: 10.1056/NEJM198403153101103. [DOI] [PubMed] [Google Scholar]
  17. Kelleher W. J., Townes B. D., Martin D. C. The Conceptual Level Analogy Test: internal consistency and relationship to demographic variables. Psychol Rep. 1984 Jun;54(3):971–976. doi: 10.2466/pr0.1984.54.3.971. [DOI] [PubMed] [Google Scholar]
  18. Larson E. B., Roach R. C., Schoene R. B., Hornbein T. F. Acute mountain sickness and acetazolamide. Clinical efficacy and effect on ventilation. JAMA. 1982 Jul 16;248(3):328–332. [PubMed] [Google Scholar]
  19. Leenders K. L., Beaney R. P., Brooks D. J., Lammertsma A. A., Heather J. D., McKenzie C. G. Dexamethasone treatment of brain tumor patients: effects on regional cerebral blood flow, blood volume, and oxygen utilization. Neurology. 1985 Nov;35(11):1610–1616. doi: 10.1212/wnl.35.11.1610. [DOI] [PubMed] [Google Scholar]
  20. Levine B. D., Yoshimura K., Kobayashi T., Fukushima M., Shibamoto T., Ueda G. Dexamethasone in the treatment of acute mountain sickness. N Engl J Med. 1989 Dec 21;321(25):1707–1713. doi: 10.1056/NEJM198912213212504. [DOI] [PubMed] [Google Scholar]
  21. McIntosh I. B., Prescott R. J. Acetazolamide in prevention of acute mountain sickness. J Int Med Res. 1986;14(5):285–287. doi: 10.1177/030006058601400510. [DOI] [PubMed] [Google Scholar]
  22. Montgomery A. B., Luce J. M., Michael P., Mills J. Effects of dexamethasone on the incidence of acute mountain sickness at two intermediate altitudes. JAMA. 1989 Feb 3;261(5):734–736. [PubMed] [Google Scholar]
  23. Roach R. C., Larson E. B., Hornbein T. F., Houston C. S., Bartlett S., Hardesty J., Johnson D., Perkins M. Acute mountain sickness, antacids, and ventilation during rapid, active ascent of Mount Rainier. Aviat Space Environ Med. 1983 May;54(5):397–401. [PubMed] [Google Scholar]
  24. Rock P. B., Johnson T. S., Cymerman A., Burse R. L., Falk L. J., Fulco C. S. Effect of dexamethasone on symptoms of acute mountain sickness at Pikes Peak, Colorado (4,300 m). Aviat Space Environ Med. 1987 Jul;58(7):668–672. [PubMed] [Google Scholar]
  25. Sampson J. B., Cymerman A., Burse R. L., Maher J. T., Rock P. B. Procedures for the measurement of acute mountain sickness. Aviat Space Environ Med. 1983 Dec;54(12 Pt 1):1063–1073. [PubMed] [Google Scholar]
  26. Sapolsky R. M., Pulsinelli W. A. Glucocorticoids potentiate ischemic injury to neurons: therapeutic implications. Science. 1985 Sep 27;229(4720):1397–1400. doi: 10.1126/science.4035356. [DOI] [PubMed] [Google Scholar]
  27. Schoene R. B. Pulmonary edema at high altitude. Review, pathophysiology, and update. Clin Chest Med. 1985 Sep;6(3):491–507. [PubMed] [Google Scholar]
  28. Singh I., Khanna P. K., Srivastava M. C., Lal M., Roy S. B., Subramanyam C. S. Acute mountain sickness. N Engl J Med. 1969 Jan 23;280(4):175–184. doi: 10.1056/NEJM196901232800402. [DOI] [PubMed] [Google Scholar]
  29. Stamper D. A., Sterner R. T., Robinson S. M. Evaluation of an acute mountain sickness questionnaire: effects of intermediate-altitude staging upon subjective symptomatology. Aviat Space Environ Med. 1980 Apr;51(4):379–387. [PubMed] [Google Scholar]
  30. White A. J. Cognitive impairment of acute mountain sickness and acetazolamide. Aviat Space Environ Med. 1984 Jul;55(7):598–603. [PubMed] [Google Scholar]
  31. Zell S. C., Goodman P. H. Acetazolamide and dexamethasone in the prevention of acute mountain sickness. West J Med. 1988 May;148(5):541–545. [PMC free article] [PubMed] [Google Scholar]

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