Acute Altitude Illness Clinical Practice Guidelines (2019)

Wilderness Medical Society

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 01, 2019

In 2019, the Wilderness Medical Society released an update to clinical practice guidelines on the prevention and treatment of acute altitude illness.[1]


Slowly increased sleeping elevation (ie, gradual ascent) is recommended to prevent acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE).

Travelers in whom ascent to high altitude poses a moderate to high risk of AMS should be strongly considered for acetazolamide administration.

Dexamethasone can be employed in place of acetazolamide in adults at moderate to high AMS risk.

Individuals who prefer not to take acetazolamide or dexamethasone or who have allergies or intolerance to these agents can be administered ibuprofen for AMS prevention.

If, over an appropriate number of weeks, patients can be regularly exposed for a sufficiently long period and factors such as sleep quality are not compromised, hypoxic tents can be employed to facilitate acclimatization and prevent AMS.

Nifedipine is recommended to prevent HAPE in persons susceptible to the condition.

Salmeterol is not recommended to prevent HAPE.


Any degree of AMS/HACE can be addressed through descent, which is indicated for persons with severe AMS or with HACE or in whom other measures fail to resolve AMS.

Descent is indicated for persons with HAPE.

Individuals with AMS, HACE, or HAPE who are waiting to initiate descent, for whom descent is not practical, or who, while severely ill, are in the process of descent, can be treated with ongoing supplemental oxygen (if available) sufficient to increase peripheral oxygen saturation (SpO2) to over 90% or provide symptom relief.

In cases where descent is delayed or infeasible and supplemental oxygen is not on hand, individuals with severe AMS or HACE should be treated with portable hyperbaric chambers, if available.

Dexamethasone treatment for AMS should be considered.

Patients with HACE should be treated with dexamethasone.

For more information, please go to Altitude Illness - Cerebral Syndromes and Altitude Illness - Pulmonary Syndromes.

For more Clinical Practice Guidelines, please go to Guidelines.


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