Treatment

Mild AMS

• Take at least one day rest when you ascend above 3000m. to allow kidneys to balance blood pH.
• Administer pain medications to reduce symptoms during rest days. OTC: aspirin, ibuprofen, naproxen sodium.
• Consider administering acetazolamide (Rx) as described under prevention.
• Increase fluids and electrolytes to maintain hydration status; monitor patient's urine.
• Diet high in carbohydrates; avoid proteins and fats.

Moderate AMS

• Stop ascent.
• Consider descending 1,000 to 2,000 foot to relieve AMS and prevent possible progression to HACE/HAPE. Drug therapy is adjunctive in nature and does not substitute for descent.
• Decrease and limit exercise.
• Consider administering supplemental oxygen.
• Consider using a Gamow Bag (a portable hyperbaric chamber) if descent is not immediately possible.
• Consider administering acetazolamide (Rx) as described in prevention.
• As adjunctive treatment for HACE consider administering steroids as anti-oedema medications if descent is not possible. Rx: dexamethasone adult dose 4 mg four times a day by mouth or intramuscular injection.

Severe AMS: HACE/HAPE

• Descend immediately 2,000 to 4,000 feet. Carry or lower the patient in a litter. Drug therapy is adjunctive in nature and does not substitute for descent.
• Use supplemental oxygen if available during descent.
• Use a Gamow Bag (a portable hyperbaric chamber) if descent is not immediately possible.
• As adjunctive treatment for HAPE consider administering Rx: nifedipine 10 mg sublingual immediately and repeated as necessary (or 30 mg slow release every 12-24 hours). Nifedipine is a strong vasodilator that decreases pulmonary atrial pressure, vascular resistance, and oedema. Continue until symptoms subside.
• As adjunctive treatment for HACE consider administering steroids as anti-oedema medications during descent. Rx: dexamethasone (adult dose) 4 mg four times a day by mouth or intramuscular injection until symptoms subside (usually within 12-24 hours); descent is still mandatory.
• Support patient in sitting or semi-reclined position to help facilitate their breathing.
• Positive pressure ventilations may be helpful but difficult during an evacuation.