Dexamethasone in the treatment of acute mountain sickness

B. D. Levine, K. Yoshimura, T. Kobayashi, M. Fukushima, T. Shibamoto, G. Ueda

Research output: Contribution to journalArticle

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Abstract

Cerebral edema occurs in fatal cases of acute mountain sickness. Dexamethasone, commonly used to treat cerebral edema due to other causes, also reduces the symptoms of acute mountain sickness when given prophylactically. However, the efficacy of dexamethasone in the treatment of established acute mountain sickness remains uncertain. To investigate this question, we exposed six men in a hypobaric chamber to a simulated altitude of 3700 m (barometric pressure, 64 kPa [481 mm Hg]), for 48 hours on two occasions. Acute mountain sickness was diagnosed with use of a symptoms questionnaire, and dexamethasone (4 mg every six hours) or placebo was then given in a randomized, double-blind, cross-over fashion. Dexamethasone reduced the symptoms of acute mountain sickness by 63 percent (P < 0.05), whereas placebo had a minimal effect (reduction by 23 percent; P not significant). In spite of this response, one subject had mild cerebral edema on brain CT after both placebo and dexamethasone. Dexamethasone had no effect on fluid shifts, oxygenation, sleep apnea, urinary catecholamine levels, the appearance of chest radiographs or perfusion scans, serum electrolyte levels, hematologic profiles, or the results of psychometric tests. Dexamethasone treatment was complicated by mild hyperglycemia in all subjects (mean [± SE] glucose level, 7.3 ± 1.3 mmol per liter [132 ± 23 mg per decililiter]). We conclude that dexamethasone effectively reduces the symptoms of acute mountain sickness. However, it did not improve objective physiologic abnormalities related to exposure to high altitudes. We therefore recommend that dexamethasone be used only when descent is impossible, or to facilitate cooperation in evacuation efforts.

Original languageEnglish (US)
Pages (from-to)1707-1713
Number of pages7
JournalNew England Journal of Medicine
Volume321
Issue number25
StatePublished - 1989

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Altitude Sickness
Dexamethasone
Brain Edema
Therapeutics
Placebos
Fluid Shifts
Sleep Apnea Syndromes
Psychometrics
Hyperglycemia
Electrolytes
Catecholamines
Thorax
Perfusion
Pressure
Glucose

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Levine, B. D., Yoshimura, K., Kobayashi, T., Fukushima, M., Shibamoto, T., & Ueda, G. (1989). Dexamethasone in the treatment of acute mountain sickness. New England Journal of Medicine, 321(25), 1707-1713.

Dexamethasone in the treatment of acute mountain sickness. / Levine, B. D.; Yoshimura, K.; Kobayashi, T.; Fukushima, M.; Shibamoto, T.; Ueda, G.

In: New England Journal of Medicine, Vol. 321, No. 25, 1989, p. 1707-1713.

Research output: Contribution to journalArticle

Levine, BD, Yoshimura, K, Kobayashi, T, Fukushima, M, Shibamoto, T & Ueda, G 1989, 'Dexamethasone in the treatment of acute mountain sickness', New England Journal of Medicine, vol. 321, no. 25, pp. 1707-1713.
Levine BD, Yoshimura K, Kobayashi T, Fukushima M, Shibamoto T, Ueda G. Dexamethasone in the treatment of acute mountain sickness. New England Journal of Medicine. 1989;321(25):1707-1713.
Levine, B. D. ; Yoshimura, K. ; Kobayashi, T. ; Fukushima, M. ; Shibamoto, T. ; Ueda, G. / Dexamethasone in the treatment of acute mountain sickness. In: New England Journal of Medicine. 1989 ; Vol. 321, No. 25. pp. 1707-1713.
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