Dr Smith is correct: children are more than ten times as susceptible to high altitude pulmonary edema as are adults.1 Physical exertion does seem to increase susceptibility and worsen symptoms,1 but it is not advisable for victims or susceptible individuals to sink into somnolent bed rest; mild activity is better. Dr Smith's observations of the value of acetazolamide are borne out by others—for example, the incidence of serious altitude sickness among the 3,500 climbers (out of 8,000 starters) who get above 4,800 m each year on Mt Kenya since use of this drug has become widespread (P. Snyder, personal communication). Double-blind studies are almost impossible: acetazolamide makes beer taste awful and causes paresthesias in extremities and around the mouth that are not due to hypocapnia. Two tablets for three days before and two days after ascent is recommended.Whether or not risk is increased if the
Houston CS. High Altitude Illness-Reply. JAMA. 1977;237(12):1199–1200. doi:10.1001/jama.1977.03270390015006
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