Acetazolamide and High Altitude Diseases A. R. Bradwell, A. D. Wright, M. Win terborn, C. fin ray Birmingham Medical Research Expeditionary Society, Department of Immunology, Medical School, University of Birmingham, Birmingham B 15 2TJ, England
Abstract A. R. Bradwell, A. D. Wright. Al. Winterhorn and C. Imray, Acetazolamide and High Altitude Diseases. mt J Sports Med, Vol 13, Suppl 1, pp S63 —S64, 1992.
Acetazolamide is a useful prophylactic for acute mountain sickness causing marked reduction in head-
ache, nausea, vomiting, weakness, etc. Improvements correlate with increased arterial oxygen concentrations, re-
duction in proteinuria and peripheral oedema and other objective measures of acute mountain sickness. Evidence that Acetazolamide is beneficial for pulmonary oedema or cerebral oedema is scanty because of the lower frequency of these severe forms of mountain sickness. Dexaniethasone, used prophylactically, also reduces the symptoms of acute mountain sickness partly due to its euphoric effect. Use of
Acetazolamide as a treatment for established acute mountain sickness has been investigated. Large doses of Acetazolamide increase arterial oxygen levels over a few hours and this leads to a reduction of symptoms but data is limited
and faster acting carbonic anhydrides inhibitors such as Methazolamide may be preferable in an emergency situation. There is no comparison of the effectiveness of Acetazolamide with other drugs used for treating acute mountain
sickness such as steroids and calcium channel blocking drugs. Also, there is no data on drug combinations which cou'd have additive effects and thereby be more beneficial than individual drugs. Key words
Acetazolamide, acute mountain sickness, arterial oxygenation, proteinuria
Acute mountain sickness (AMS) is a well docu-
high altitude, and the incidence of the mild form may be as
mented disease that occurs in people ascending to altitudes greater than 3,000 m. The clinical presentation is variabk and depends upon the rate of ascent and individual susceptibility. In its mild form nausea, lassitude and headache are promi-
high as 50% (4). High altitude climbers, skiers, and soldiers are also affected.
nent, whilst in the severe form both pulmonary oedema (HAPE) and cerebral oedema (HACE) may occur and can lead to death. The severe form occurs in 4.3% of trekkers to tnt. J. SportsMed. 13(1992) S63—S64 Georg Thieme Verlag StuttgartNew York
Acetazolamide (Az) has been used for nearly 20 years to prevent or attenuate AMS through its effect on stimulation of respiration, and many reports have shown its efficacy in controlled studies (1). One report (1) on 20 subjects at 5,000 m showed reduced symptoms of AMS (p < 0.02) whilst taking Az compared with placebo and subjects improved their
performance compared with a previous similar expedition
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mt. I Sports Med. 13(1992) S63
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