For healthcare professionals only

Practice 10-Minute Consultation

Altitude sickness and acetazolamide

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2153 (Published 31 May 2018) Cite this as: BMJ 2018;361:k2153
  1. Jonathan Williamson, junior doctor1,
  2. Pippa Oakeshott, professor of general practice2,
  3. Jon Dallimore, general practitioner3
  1. 1St George’s Hospital, London, UK
  2. 2Population Health Research Institute, St George’s Hospital, University of London, UK
  3. 3Bristol Royal Infirmary, Bristol, UK
  1. Correspondence to J Williamson jdwilliamson115{at}gmail.com
  • Accepted 9 May 2018

What you need to know

  • Help prevent mountain sickness by slow ascents ≤500 m/day, rest days every third day, and avoid over-exertion

  • The most important treatment for altitude sickness is descent to a lower, more oxygen-rich environment

  • Acetazolamide 125 mg twice daily can be prescribed as prophylaxis for those at risk of developing acute mountain sickness

A 25 year old man plans to trek to Everest Base Camp (5545 m) in Nepal for charity. He asks you for a prescription of acetazolamide to prevent mountain sickness.

For most people, mountain sickness is a self limiting illness, but it can become life threatening. It is estimated that more than 100 million people per year travel to the hypoxic environments found at altitudes above 2500 m,1 and at least 10% to 20% of unacclimatised individuals develop acute mountain sickness at this height.2 Acclimatisation to altitude involves multiple physiological changes, occurring over days to weeks, which enable individuals to function better in these hypoxic environments. If this natural adaptation is surpassed by the rate of exposure to altitude, acute mountain sickness can occur. Acetazolamide can help to prevent acute mountain sickness developing and has fewer side effects than alternative drugs such as dexamethasone, which can mask symptoms and therefore carries greater risks.2345 Acetazolamide causes mild diuresis and increases renal excretion of bicarbonate, causing a mild metabolic acidosis which in turn increases respiratory rate (improving oxygenation).

In the UK, prescribing acetazolamide for travel is an optional service, not included in the general practitioner’s contract. Some GPs may decide not to prescribe acetazolamide on this basis, or because they feel it is outside the scope of their practice.

This article is an approach to discussing travel and activity at high altitude, prevention of sickness, and acetazolamide prescription for non-specialists.

What you should cover

History

What does the person know about acute mountain sickness?

Symptoms of acute mountain sickness …

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