Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update

Luks A.M. McIntosh S.E. Grissom C.K. Auerbach P.S. Rodway G.W. Schoene R.B. et al.

Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness.

Wilderness Environ Med. 21: 146-155Luks A.M. McIntosh S.E. Grissom C.K. Auerbach P.S. Rodway G.W. Schoene R.B. et al.

Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update.

Wilderness Environ Med. 25: S4-S14Luks A.M. Auerbach P.S. Freer L. Grissom C.K. Keyes L.E. McIntosh S.E. et al.

Wilderness Medical Society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update.

Wilderness Environ Med. 30: S3-S18Diekemper R.L. Patel S. Mette S.A. Ornelas J. Ouellette D.R. Casey K.R.

Making the GRADE: CHEST updates its methodology.

Chest. 153: 756-759Montgomery A.B. Mills J. Luce J.M.

Incidence of acute mountain sickness at intermediate altitude.

JAMA. 261: 732-734Honigman B. Theis M.K. Koziol-McLain J. Roach R. Yip R. Houston C. et al.

Acute mountain sickness in a general tourist population at moderate altitudes.

Ann Intern Med. 118: 587-592Gabry A.L. Ledoux X. Mozziconacci M. Martin C.

High-altitude pulmonary edema at moderate altitude (< 2,400 m; 7,870 feet): a series of 52 patients.

Chest. 123: 49-53Hackett P.H. Yarnell P.R. Weiland D.A. Reynard K.B.

Acute and evolving MRI of high-altitude cerebral edema: microbleeds, edema, and pathophysiology.

AJNR Am J Neuroradiol. 40: 464-469Southard A. Niermeyer S. Yaron M.

Language used in Lake Louise Scoring System underestimates symptoms of acute mountain sickness in 4- to 11-year-old children.

High Alt Med Biol. 8: 124-130Muhm J.M. Rock P.B. McMullin D.L. Jones S.P. Lu I.L. Eilers K.D. et al.

Effect of aircraft-cabin altitude on passenger discomfort.

N Engl J Med. 357: 18-27Theis M.K. Honigman B. Yip R. McBride D. Houston C.S. Moore L.G.

Acute mountain sickness in children at 2835 meters.

Am J Dis Child. 147: 143-145

High-altitude illness.

N Engl J Med. 345: 107-114

High altitude cerebral edema.

High Alt Med Biol. 5: 136-146

Clinical practice: acute high-altitude illnesses.

N Engl J Med. 368: 2294-2302Hackett P.H. Luks A.M. Lawley J.S. Roach R.C.

High altitude medicine and pathophysiology.

in: Auerbach P.S. Auerbach’s Wilderness Medicine. Elsevier, : 8-29Turner R.E.F. Gatterer H. Falla M. Lawley J.S.

High-altitude cerebral edema: its own entity or end-stage acute mountain sickness?.

J Appl Physiol (1985). 131: 313-325Hackett P.H. Rennie D. Levine H.D.

The incidence, importance, and prophylaxis of acute mountain sickness.

Lancet. 2: 1149-1155Bloch K.E. Turk A.J. Maggiorini M. Hess T. Merz T. Bosch M.M. et al.

Effect of ascent protocol on acute mountain sickness and success at Muztagh Ata, 7546 m.

High Alt Med Biol. 10: 25-32Beidleman B.A. Fulco C.S. Muza S.R. Rock P.B. Staab J.E. Forte V.A. et al.

Effect of six days of staging on physiologic adjustments and acute mountain sickness during ascent to 4300 meters.

High Alt Med Biol. 10: 253-260Staab J.E. Muza S.R. Fulco C.S. Andrew S.P. Beidleman B.A.

Impact of 2 days of staging at 2500-4300 m on sleep quality and quantity following subsequent exposure to 4300 m.

Physiol Rep. 9e15063Forwand S.A. Landowne M. Follansbee J.N. Hansen J.E.

Effect of acetazolamide on acute mountain sickness.

N Engl J Med. 279: 839-845Basnyat B. Gertsch J.H. Holck P.S. Johnson E.W. Luks A.M. Donham B.P. et al.

Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial.

High Alt Med Biol. 7: 17-27van Patot M.C. Leadbetter 3rd, G. Keyes L.E. Maakestad K.M. Olson S. Hackett P.H.

Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness.

High Alt Med Biol. 9: 289-293Low E.V. Avery A.J. Gupta V. Schedlbauer A. Grocott M.P.

Identifying the lowest effective dose of acetazolamide for the prophylaxis of acute mountain sickness: systematic review and meta-analysis.

BMJ. 345: e6779

Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness.

Chest. 133: 744-755

Acetazolamide and sulfonamide allergy: a not so simple story.

High Alt Med Biol. 11: 319-323Garske L.A. Brown M.G. Morrison S.C.

Acetazolamide reduces exercise capacity and increases leg fatigue under hypoxic conditions.

J Appl Physiol (1985). 94: 991-996Elisabeth E. Hannes G. Johannes B. Martin F. Elena P. Martin B.

Effects of low-dose acetazolamide on exercise performance in simulated altitude.

Int J Physiol Pathophysiol. Pharmacol. 9: 28-34Bradwell A.R. Myers S.D. Beazley M. Ashdown K. Harris N.G. Bradwell S.B. et al.

Exercise limitation of acetazolamide at altitude (3459 m).

Wilderness Environ Med. 25: 272-277Fulco C.S. Muza S.R. Ditzler D. Lammi E. Lewis S.F. Cymerman A.

Effect of acetazolamide on leg endurance exercise at sea level and simulated altitude.

Clin Sci (Lond). 110: 683-692Gonzales J.U. Scheuermann B.W.

Effect of acetazolamide on respiratory muscle fatigue in humans.

Respir Physiol Neurobiol. 185: 386-392Bradbury K.E. Yurkevicius B.R. Mitchell K.M. Coffman K.E. Salgado R.M. Fulco C.S. et al.

Acetazolamide does not alter endurance exercise performance at 3,500-m altitude.

J Appl Physiol (1985). 128: 390-396McIntosh S.E. Hemphill M. McDevitt M.C. Gurung T.Y. Ghale M. Knott J.R. et al.

Reduced acetazolamide dosing in countering altitude illness: a comparison of 62.5 vs 125 mg (the RADICAL Trial).

Wilderness Environ Med. 30: 12-21Lipman G.S. Jurkiewicz C. Burnier A. Marvel J. Phillips C. Lowry C. et al.

A randomized controlled trial of the lowest effective dose of acetazolamide for acute mountain sickness prevention.

Am J Med. 133: e706-e715Pollard A.J. Niermeyer S. Barry P. Bärtsch P. Berghold F. Bishop R.A. et al.

Children at high altitude: an international consensus statement by an ad hoc committee of the International Society for Mountain Medicine, March 12, 2001.

High Alt Med Biol. 2: 389-403Lipman G.S. Jurkiewicz C. Winstead-Derlega C. Navlyt A. Burns P. Walker A. et al.

Day of ascent dosing of acetazolamide for prevention of acute mountain sickness.

High Alt Med Biol. 20: 271-278Johnson 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. 310: 683-686Ellsworth A.J. Larson E.B. Strickland D.

A randomized trial of dexamethasone and acetazolamide for acute mountain sickness prophylaxis.

Am J Med. 83: 1024-1030Rock 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. 58: 668-672Ellsworth A.J. Meyer E.F. Larson E.B.

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

West J Med. 154: 289-293Zheng C.R. Chen G.Z. Yu J. Qin J. Song P. Bian S.Z. et al.

Inhaled budesonide and oral dexamethasone prevent acute mountain sickness.

Am J Med. 127: 1001-1009.e2Chen G.Z. Zheng C.R. Qin J. Yu J. Wang H. Zhang J.H. et al.

Inhaled budesonide prevents acute mountain sickness in young Chinese men.

J Emerg Med. 48: 197-206Berger M.M. Macholz F. Sareban M. Schmidt P. Fried S. Dankl D. et al.

Inhaled budesonide does not prevent acute mountain sickness after rapid ascent to 4559 m.

Eur Respir J. 501700982Lipman G.S. Pomeranz D. Burns P. Phillips C. Cheffers M. Evans K. et al.

Budesonide versus acetazolamide for prevention of acute mountain sickness.

Am J Med. 131: 200.e9-200.e16Roncin J.P. Schwartz F. D’Arbigny P.

EGb 761 in control of acute mountain sickness and vascular reactivity to cold exposure.

Aviat Space Environ Med. 67: 445-452Moraga F.A. Flores A. Serra J. Esnaola C. Barriento C.

Ginkgo biloba decreases acute mountain sickness in people ascending to high altitude at Ollague (3696 m) in northern Chile.

Wilderness Environ Med. 18: 251-257Gertsch J.H. Basnyat B. Johnson E.W. Onopa J. Holck P.S.

Randomised, double blind, placebo controlled comparison of ginkgo biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers: the prevention of high altitude illness trial (PHAIT).

BMJ. 328: 797Chow T. Browne V. Heileson H.L. Wallace D. Anholm J. Green S.M.

Ginkgo biloba and acetazolamide prophylaxis for acute mountain sickness: a randomized, placebo-controlled trial.

Arch Intern Med. 165: 296-301Leadbetter G. Keyes L.E. Maakestad K.M. Olson S. Tissot van Patot M.C. Hackett P.H.

Ginkgo biloba does--and does not--prevent acute mountain sickness.

Wilderness Environ Med. 20: 66-71Dugoua J.J. Mills E. Perri D. Koren G.

Safety and efficacy of ginkgo (Ginkgo biloba) during pregnancy and lactation.

Can J Clin Pharmacol. 13: e277-e284Stoddard G.J. Archer M. Shane-McWhorter L. Bray B.E. Redd D.F. Proulx J. et al.

Ginkgo and warfarin interaction in a large Veterans Administration population.

AMIA Annu Symp Proc. 2015: 1174-1183Gertsch J.H. Corbett B. Holck P.S. Mulcahy A. Watts M. Stillwagon N.T. et al.

Altitude Sickness in Climbers and Efficacy of NSAIDs Trial (ASCENT): randomized, controlled trial of ibuprofen versus placebo for prevention of altitude illness.

Wilderness Environ Med. 23: 307-315Lipman G.S. Kanaan N.C. Holck P.S. Constance B.B. Gertsch J.H. PAINS Group

Ibuprofen prevents altitude illness: a randomized controlled trial for prevention of altitude illness with nonsteroidal anti-inflammatories.

Ann Emerg Med. 59: 484-490Lundeberg J. Feiner J.R. Schober A. Sall J.W. Eilers H. Bickler P.E.

Increased cytokines at high altitude: lack of effect of ibuprofen on acute mountain sickness, physiological variables, or cytokine levels.

High Alt Med Biol. 19: 249-258Kanaan N.C. Peterson A.L. Pun M. Holck P.S. Starling J. Basyal B. et al.

Prophylactic acetaminophen or ibuprofen results in equivalent acute mountain sickness incidence at high altitude: a prospective randomized trial.

Wilderness Environ Med. 28: 72-78Gertsch J.H. Lipman G.S. Holck P.S. Merritt A. Mulcahy A. Fisher R.S. et al.

Prospective, double-blind, randomized, placebo-controlled comparison of acetazolamide versus ibuprofen for prophylaxis against high altitude headache: the Headache Evaluation at Altitude Trial (HEAT).

Wilderness Environ Med. 21: 236-243Burns P. Lipman G.S. Warner K. Jurkiewicz C. Phillips C. Sanders L. et al.

Altitude sickness prevention with ibuprofen relative to acetazolamide.

Am J Med. 132: 247-251Baggish A.L. Fulco C.S. Muza S. Rock P.B. Beidleman B. Cymerman A. et al.

The impact of moderate-altitude staging on pulmonary arterial hemodynamics after ascent to high altitude.

High Alt Med Biol. 11: 139-145Lyons T.P. Muza S.R. Rock P.B. Cymerman A.

The effect of altitude pre-acclimatization on acute mountain sickness during reexposure.

Aviat Space Environ Med. 66: 957-962Beidleman B.A. Muza S.R. Fulco C.S. Cymerman A. Ditzler D. Stulz D. et al.

Intermittent altitude exposures reduce acute mountain sickness at 4300 m.

Clin Sci (Lond). 106: 321-328Wille M. Gatterer H. Mairer K. Philippe M. Schwarzenbacher H. Faulhaber M. et al.

Short-term intermittent hypoxia reduces the severity of acute mountain sickness.

Scand J Med Sci Sports. 22: e79-e85Burse R.L. Forte Jr., V.A.

Acute mountain sickness at 4500 m is not altered by repeated eight-hour exposures to 3200-3550 m normobaric hypoxic equivalent.

Aviat Space Environ Med. 59: 942-949Schommer K. Wiesegart N. Menold E. Haas U. Lahr K. Buhl H. et al.

Training in normobaric hypoxia and its effects on acute mountain sickness after rapid ascent to 4559 m.

High Alt Med Biol. 11: 19-25Fulco C.S. Muza S.R. Beidleman B.A. Demes R. Staab J.E. Jones J.E. et al.

Effect of repeated normobaric hypoxia exposures during sleep on acute mountain sickness, exercise performance, and sleep during exposure to terrestrial altitude.

Am J Physiol Regul Integr Comp Physiol. 300: R428-R436Faulhaber M. Pocecco E. Gatterer H. Niedermeier M. Huth M. Dünnwald T. et al.

Seven passive 1-h hypoxia exposures do not prevent AMS in susceptible individuals.

Med Sci Sports Exerc. 48: 2563-2570Fulco C.S. Beidleman B.A. Muza S.R.

Effectiveness of preacclimatization strategies for high-altitude exposure.

Exerc Sport Sci Rev. 41: 55-63Dehnert C. Böhm A. Grigoriev I. Menold E. Bärtsch P.

Sleeping in moderate hypoxia at home for prevention of acute mountain sickness (AMS): a placebo-controlled, randomized double-blind study.

Wilderness Environ Med. 25: 263-271Delamere J.P. Bradwell S.B. Lewis C.T. Clarke A. Bradwell A.R.

Losartan has no effect on high altitude diuresis or acute mountain sickness in well-acclimatizing individuals.

High Alt Med Biol. 22: 96-101Baillie J.K. Thompson A.A. Irving J.B. Bates M.G. Sutherland A.I. Macnee W. et al.

Oral antioxidant supplementation does not prevent acute mountain sickness: double blind, randomized placebo-controlled trial.

QJM. 102: 341-348Talbot N.P. Smith T.G. Privat C. Nickol A.H. Rivera-Ch M. León-Velarde F. et al.

Intravenous iron supplementation may protect against acute mountain sickness: a randomized, double-blinded, placebo-controlled trial.

High Alt Med Biol. 12: 265-269Rossetti G.M.K. Macdonald J.H. Wylie L.J. Little S.J. Newton V. Wood B. et al.

Dietary nitrate supplementation increases acute mountain sickness severity and sense of effort during hypoxic exercise.

J Appl Physiol (1985). 123: 983-992Grissom C.K. Richer L.D. Elstad M.R.

The effects of a 5-lipoxygenase inhibitor on acute mountain sickness and urinary leukotriene e4 after ascent to high altitude.

Chest. 127: 565-570Luks A.M. Henderson W.R. Swenson E.R.

Leukotriene receptor blockade does not prevent acute mountain sickness induced by normobaric hypoxia.

High Alt Med Biol. 8: 131-138Bates M.G. Thompson A.A. Baillie J.K. Sutherland A.I. Irving J.B. Hirani N. et al.

Sildenafil citrate for the prevention of high altitude hypoxic pulmonary hypertension: double blind, randomized, placebo-controlled trial.

High Alt Med Biol. 12: 207-214Kayser B. Hulsebosch R. Bosch F.

Low-dose acetylsalicylic acid analog and acetazolamide for prevention of acute mountain sickness.

High Alt Med Biol. 9: 15-23Basnyat B. Holck P.S. Pun M. Halverson S. Szawarski P. Gertsch J. et al.

Spironolactone does not prevent acute mountain sickness: a prospective, double-blind, randomized, placebo-controlled trial by SPACE Trial Group (spironolactone and acetazolamide trial in the prevention of acute mountain sickness group).

Wilderness Environ Med. 22: 15-22Jafarian S. Gorouhi F. Salimi S. Lotfi J.

Sumatriptan for prevention of acute mountain sickness: randomized clinical trial.

Ann Neurol. 62: 273-277Castellani J.W. Muza S.R. Cheuvront S.N. Sils I.V. Fulco C.S. Kenefick R.W. et al.

Effect of hypohydration and altitude exposure on aerobic exercise performance and acute mountain sickness.

J Appl Physiol (1985). 109: 1792-1800Lipman G.S. Kanaan N.C. Phillips C. Pomeranz D. Cain P. Fontes K. et al.

Study looking at end expiratory pressure for altitude illness decrease (SLEEP-AID).

High Alt Med Biol. 16: 154-161Berger M.M. Macholz F. Lehmann L. Dankl D. Hochreiter M. Bacher B. et al.

Remote ischemic preconditioning does not prevent acute mountain sickness after rapid ascent to 3,450 m.

J Appl Physiol (1985). 123: 1228-1234Richalet J.P. Larmignat P. Poitrine E. Letournel M. Canouï-Poitrine F.

Physiological risk factors for severe high-altitude illness: a prospective cohort study.

Am J Respir Crit Care Med. 185: 192-198Beidleman B.A. Fulco C.S. Cymerman A. Staab J.E. Buller M.J. Muza S.R.

New metric of hypoxic dose predicts altitude acclimatization status following various ascent profiles.

Physiol Rep. 7e14263

Avoiding mountain sickness.

Lancet. 2: 938Bernhard W.N. Schalick L.M. Delaney P.A. Bernhard T.M. Barnas G.M.

Acetazolamide plus low-dose dexamethasone is better than acetazolamide alone to ameliorate symptoms of acute mountain sickness.

Aviat Space Environ Med. 69: 883-886Roach R.C. Bartsch P. Hackett P.H. Oelz O.

The Lake Louise acute mountain sickness scoring system.

in: Sutton J.R. Coates G. Houston C.S. Hypoxia and Molecular Medicine: Proceedings of the 8th International Hypoxia Symposium, Lake Louise, Alberta, Canada. Queen City Printers, : 272-274Roach R.C. Hackett P.H. Oelz O. Bärtsch P. Luks A.M. MacInnis M.J. et al.

The 2018 Lake Louise acute mountain sickness score.

High Alt Med Biol. 19: 4-6Sampson 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. 54: 1063-1073Roach R. Kayser B. Hackett P.

Pro: headache should be a required symptom for the diagnosis of acute mountain sickness.

High Alt Med Biol. 12 (): 21-22

Con: headache should not be a required symptom for the diagnosis of acute mountain sickness.

High Alt Med Biol. 12 (): 23-25Macinnis M.J. Lanting S.C. Rupert J.L. Koehle M.S.

Is poor sleep quality at high altitude separate from acute mountain sickness? Factor structure and internal consistency of the Lake Louise Score Questionnaire.

High Alt Med Biol. 14: 334-337Hall D.P. MacCormick I.J. Phythian-Adams A.T. Rzechorzek N.M. Hope-Jones D. Cosens S. et al.

Network analysis reveals distinct clinical syndromes underlying acute mountain sickness.

PLoS One. 9e81229Richalet J.P. Julia C. Lhuissier F.J.

Evaluation of the Lake Louise score for acute mountain sickness and its 2018 version in a cohort of 484 trekkers at high altitude.

High Alt Med Biol. 22: 353-361Meier D. Collet T.H. Locatelli I. Cornuz J. Kayser B. Simel D.L. et al.

Does this patient have acute mountain sickness?: the rational clinical examination systematic review.

JAMA. 318: 1810-1819

High altitude cerebral edema: cerebral acute mountain sickness.

Semin Respir Crit Care Med. 5: 151-158Wu T. Ding S. Liu J. Jia J. Dai R. Liang B. et al.

Ataxia: an early indicator in high altitude cerebral edema.

High Alt Med Biol. 7: 275-280Keyes L.E. Paterson R. Boatright D. Browne V. Leadbetter G. Hackett P.

Optic nerve sheath diameter and acute mountain sickness.

Wilderness Environ Med. 24: 105-111Kanaan N.C. Lipman G.S. Constance B.B. Holck P.S. Preuss J.F. Williams S.R. et al.

Optic nerve sheath diameter increase on ascent to high altitude: correlation with acute mountain sickness.

J Ultrasound Med. 34: 1677-1682Schommer K. Kallenberg K. Lutz K. Bärtsch P. Knauth M.

Hemosiderin deposition in the brain as footprint of high-altitude cerebral edema.

Neurology. 81: 1776-1779Bärtsch P. Merki B. Hofstetter D. Maggiorini M. Kayser B. Oelz O.

Treatment of acute mountain sickness by simulated descent: a randomised controlled trial.

BMJ. 306: 1098-1101Keller H.R. Maggiorini M. Bärtsch P. Oelz O.

Simulated descent v dexamethasone in treatment of acute mountain sickness: a randomised trial.

BMJ. 310: 1232-1235

Protocols for the use of a portable hyperbaric chamber for the treatment of high altitude disorders.

J Wilderness Med. 1: 181-192Grissom C.K. Roach R.C. Sarnquist F.H. Hackett P.H.

Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange.

Ann Intern Med. 116: 461-465Ferrazzini G. Maggiorini M. Kriemler S. Bärtsch P. Oelz O.

Successful treatment of acute mountain sickness with dexamethasone.

Br Med J (Clin Res Ed). 294: 1380-1382Hackett P.H. Roach R.C. Wood R.A. Foutch R.G. Meehan R.T. Rennie D. et al.

Dexamethasone for prevention and treatment of acute mountain sickness.

Aviat Space Environ Med. 59: 950-954Levine B.D. Yoshimura K. Kobayashi T. Fukushima M. Shibamoto T. Ueda G.

Dexamethasone in the treatment of acute mountain sickness.

N Engl J Med. 321: 1707-1713Harris N.S. Wenzel R.P. Thomas S.H.

High altitude headache: efficacy of acetaminophen vs. ibuprofen in a randomized, controlled trial.

J Emerg Med. 24: 383-387Johnson P.L. Johnson C.C.

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