Acute Altitude Illness — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Type
   Type (AMS / HACE / HAPE)? (Usually with rapid ascent to high altitude (>2500 m). AMS: headache + fatigue/GI/dizziness/poor sleep. HACE: cerebral edema — ataxia, altered consciousness/drowsiness → coma. HAPE: non-cardiogenic pulmonary edema — dyspnea at rest, cough, hypoxemia, crackles. Clinical diagnosis. General rule: stop ascending; descent is most important.)
   • HACE (cerebral edema) → HACE → immediate descent + dexamethasone
   • HAPE (pulmonary edema) → HAPE → immediate descent + oxygen + nifedipine
   • AMS (mild) → AMS (mild)
2. [End] AMS (mild)
   Stop ascending, rest, hydrate, non-opioid analgesia for headache; acetazolamide 250 mg bid (aids acclimatization) ± dexamethasone. If symptoms do not ease or worsen → descend 500–1000 m, oxygen.
3. [End] HACE → immediate descent + dexamethasone
   Cerebral edema, life-threatening: immediate descent (most important) + dexamethasone (8 mg first dose → 4 mg q6h PO/IM/IV) + oxygen ± portable hyperbaric bag. Monitor airway and consciousness.
4. [End] HAPE → immediate descent + oxygen + nifedipine
   Non-cardiogenic pulmonary edema, life-threatening (the most common cause of death): immediate descent ≥1000 m, minimize exertion + oxygen (target SpO2 >90%) ± nifedipine (immediate-release 10 mg → extended-release 30 mg q12h, lowers pulmonary artery pressure); a PDE5 inhibitor (tadalafil/sildenafil) is an alternative; use a portable hyperbaric bag if descent is impossible. Diuretics/acetazolamide are not used to treat HAPE; add dexamethasone if HACE/neurological symptoms coexist.

Source guidelines & references

• WMS guidelines for prevention and treatment of acute altitude illness; CDC high-altitude travel

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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