野外與登山醫學----16--- WMS 2019 update AMS/HACE Treatment Dexamethasone 16

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
acute altitude illness 急性高海拔疾病

地塞米松(下面直接稱類固醇). 

類固醇對於治療AMS的效果比丹木斯強. 但無加速高度適應的效果. 如果要繼續往上攀登(增加海拔高度). 應等藥效完全消失再看看是否又出現高海拔反應. 雖然無系統性研究. 但大量臨床經驗支持使用類固醇治療HACE

Dexamethasone Dexamethasone is very effective for treating AMS.73e75 The medication does not facilitate acclimatization, so further ascent should be delayed until the patient is asymptomatic while off the medication. Although systematic studies have not been conducted, extensive clinical experience supports using dexamethasone in patients with HACE. It is administered as an 8 mg dose (intramuscularly, IV, or orally) followed by 4 mg every 6 h until symptoms resolve. The pediatric dose is 0.15 mg$kg-1$dose-1 every 6 h.27

Recommendation. 

Dexamethasone should be considered for treatment of AMS. 

Recommendation Grade 1B. 

Recommendation. 

Dexamethasone should be administered to patients with HACE. Recommendation Grade: 1B

補充

dexamethasone 如果連續使用10天以上. 突然停藥可能引起戒斷症狀

Dexamethasone withdrawal symptoms include fatigue, muscle and joint pain, nausea, vomiting, and weight loss. Other symptoms can include fever, headache, confusion, skin changes, and a general feeling of being unwell.