Acetazolamide (Diamox) to Reduce the Symptoms of High Altitude Illness
Sunday, October 21, 2007
Paul Auerbach, M.D.
I’m very often asked about the role of acetazolamide (Diamox) in reducing the symptoms of high altitude. Acetazolamide (Diamox) can be a very useful drug to diminish or prevent acute mountain sickness (AMS). It stimulates breathing, which diminishes the sleep disorder associated with AMS. This enables the body to adjust (acclimatize) more rapidly to high altitude, and increases the amount of oxygen that gets into the bloodstream during sleep. It can also be used to treat mild AMS (headache, fitful or disturbed sleeping, fatigue, loss of appetite, nausea, dizziness, drowsiness). However, it is very important to be aware of acetazolamide-induced side effects, which include increased urination (the drug is a diuretic and can induce dehydration), numbness and tingling of the hands and feet on exposure to rapid temperature change, and altered taste of carbonated beverages – you can taste the carbon dioxide bubbles, and they are bitter.
I take acetazolamide with me when I ascend to high altitude, because I am prone to mountain sickness when I get above 10,000 feet. In Nepal, I noticed that when I washed my hands in hot water in the morning while in a frigid environment, the numbness and tingling were so bad that I developed spasm of my fingers, hand, and wrist muscles. Also, the beer didn’t taste very good. (I only tasted it – we weren’t allowed to drink alcohol during ascent and until after we were acclimatized at the highest altitude where we were intended to sleep.) The dehydration can sneak up on a person, so it’s important to drink lots of liquids and observe copious output of clear (non-concentrated), light-colored (not dark yellow) urine.
The most important aspect of this discussion is recognition that high altitude illness is probably more common than we suspect. Any person traveling from low altitude (usually, sea level) to an altitude at or above 6,000 feet (1,830 meters) should anticipate the possibility of high altitude ilness, specifically acute mountain sickness (AMS). I have recently heard of a few persons who reported symptoms, including headache and nausea, that appeared to have been caused by rapid ascent to altitudes as low as 4,500 feet (1,372 meters), so they might also be amenable to acetazolamide use if their affliction is recurrent. Please remember - ascend slowly, stay well hydrated, and gradually increase your exertion when traveling to high altitudes.
Tags: high altitude, acetazolamide, medical, Diamox, acute mountain sickness, wilderness medicine, outdoor medicine, healthline
photo by Janice Weixelman
3 Comments:
At Sun Oct 21, 05:50:00 PM 2007,
Jeremy Joslin, MD said…
You mention that altitude sickness may be more common than we think. A colleague and I were just talking about this the other day. We were going back and forth about the cabin pressure in planes and how some of that terrible "jet lag" feeling could possibly be attributed to a component of altitude sickness. Sure the cabin pressure isn't usually much more than 7-8k feet from what I've read, but perhaps even at this pressure/altitude there's an effect that we feel.
At Sat Sep 20, 01:49:00 PM 2008,
Stephen L. Stewart, PA-C, CMA said…
My question is the same as Dr. Joslin. How much of “jet lag” is related to undiagnosed Altitude Sickness. If it is a component what about the affect on private pilots.
SLS
At Tue Sep 23, 09:59:00 AM 2008,
Paul Auerbach, M.D. said…
This is an interesting idea, but I can only hypothesize the answer. Jet lag is generally noticed in persons who cross time zones, not in persons who fly for prolonged periods within the same time zones, which would make it less likely to be related to the altitude. Certainly, exposure to an altitude equivalent to 8,000 feet in an non-enriched (oxygen) environment for 8 or more hours might create an element of acute mountain sickness, but if that were the case, I think we would see it more often. To definitively answer this question, it would be necessary to do a broad epidemiological study, and perhaps add physiological measurements. We know that the hypoxia associated with flying can contribute to exacerbations of pre-existing conditions such as sickle cell disease, so incipient AMS when flying in airplanes for a sufficiently lengthy time period is not an unreasonable thought.
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