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Journal of the American Veterinary... Mar 2012To critically evaluate and summarize available information on the safety of potassium bromide in dogs. (Review)
Review
OBJECTIVE
To critically evaluate and summarize available information on the safety of potassium bromide in dogs.
DESIGN
Systematic review.
SAMPLE
111 references reporting safety information relevant to potassium bromide published between 1938 and 2011.
PROCEDURES
PubMed searches without date limitations were conducted with the terms "potassium bromide" and "sodium bromide" in December 2009 and October 2011. Additional articles were identified through examination of article reference lists and book chapters on seizures in dogs and pharmacology.
RESULTS
Reversible neurologic signs were the most consistently reported toxicoses and were generally associated with adjunctive potassium bromide treatment or high serum bromide concentrations. Dermatologic and respiratory abnormalities were rare in dogs. Insufficient information was available to assess the effects of potassium bromide on behavior or to determine the incidence of vomiting, weight gain, polyphagia, pancreatitis, polyuria, polydipsia, or reproductive abnormalities associated with potassium bromide administration. Evidence suggested that administration of potassium bromide with food may alleviate gastrointestinal irritation and that monitoring for polyphagia, thyroid hormone abnormalities, and high serum bromide concentrations may be beneficial.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that potassium bromide is not an appropriate choice for treatment of every dog with seizures and that practitioners should tailor therapeutic regimens and clinical monitoring to each dog. Abrupt dietary changes or fluid therapy may compromise seizure control or increase the likelihood of adverse events. Availability of an appropriately labeled, approved potassium bromide product could provide better assurance for veterinarians and their clients of the quality, safety, and effectiveness of the product for veterinary use.
Topics: Animals; Anticonvulsants; Bromides; Dog Diseases; Dogs; Potassium Compounds; Seizures
PubMed: 22380809
DOI: 10.2460/javma.240.6.705 -
JBI Library of Systematic Reviews 2012The review question is: Are metabolic outcomes improved in outpatient adolescents (aged 13 to 19 years) with type 1 diabetes on a Continuous Subcutaneous Insulin...
REVIEW QUESTION/OBJECTIVE
The review question is: Are metabolic outcomes improved in outpatient adolescents (aged 13 to 19 years) with type 1 diabetes on a Continuous Subcutaneous Insulin Infusion (CSII) when continuous glucose monitoring is used, compared to self-glucose monitoring alone?
BACKGROUND
Type 1 diabetes is the most common childhood paediatric disease, characterised by impairment of insulin producing βeta-cells in the pancreas. Internationally, there is variation in the incidence of type 1 diabetes in paediatric patients. According to the Center for Disease Control and Prevention (CDC) and the SEARCH for Diabetes in Youth Study Group, the overall incidence rate of this autoimmune disease is 24.3/100,000 in those 19 years of age . Annually, more than 15,000 children and adolescents are diagnosed in the United States (US) . From 1990 to 1999, the World Health Organization (WHO) launched the Multinational Project for Childhood Diabetes (DIAMOND), which was tasked with assessing type 1 diabetes in those 14 years or younger worldwide . Finland was discovered to have the highest age-adjusted incidence at 40.9 cases per 100,000/year. The lowest age-adjusted incidence is in China and Venezuela at 0.1 cases per 100,000/year. Globally, the largest increase in incidence is in those aged 10 to 14 years . This systematic review will focus on adolescent patients with type 1 diabetes, aged 13 to 19 years who manage their diabetes with an insulin pump.Patients with type 1 diabetes mellitus typically present with a history of polydipsia, polyuria, polyphagia, and weight loss . Initial findings include hyperglycemia, glycosuria, and ketones in the blood or urine . In 2009, the International Expert Committee deemed a haemoglobin A1C (glycosylated haemoglobin) of 6.5% or higher to be the standard for diagnosis . The American Diabetes Association (ADA) as well as the International Diabetes Federation and the European Association Study of Diabetes (EASD) accept this measure as the diagnostic tool for diabetes. Haemoglobin A1C is the most commonly used measurement for patients with type 1 diabetes . It refers to the measurement of the amount of glucose bound to haemoglobin. It is an average of blood glucose levels for the last 120 days, which is consistent with the average life span of a red blood cell (RBC).Compensation for the lack of insulin-secreting βeta-cells is accomplished through administration of insulin. For adolescents, insulin dosing is based on pubescent status, age, weight, activity level, and amount of carbohydrates consumed . Insulin administration, carbohydrate counting, and correction of hyperglycemia are necessary for maintaining glycemic control. Insulin can be administered through multiple daily injections (MDI) of rapid, intermediate and long-acting insulin .Another form of insulin delivery is the Continuous Subcutaneous Insulin Infusion (CSII), also known as an insulin pump, which is designed to meet physiological requirements through programmable basal rates and bolus doses . CSII's utilise rapid-acting insulin and establish a basal rate, which replaces the need for long-acting insulin. Bolus dosing is accomplished through adjusting the pump and is utilised to account for nutritional intake as well as hyperglycemia correction. Adjustments are also made for physical activity and exercise, as this can affect glucose levels . All patients considered in this systematic review will be utilising insulin pumps.In 2006, the United States had more than 35,000 patients, under the age of 21 years, receiving insulin therapy through an insulin pump . In Europe, the percentage of people with type 1 diabetes utilising a CSII is lower, potentially due to variation in health care coverage . There are various forms of insulin pumps, all with similar capabilities including a dose calculator for high blood glucose correction and carbohydrate ratios, programming software, and several other features . Software and programming is specific to each manufacturer. Basal rate abilities vary in each model from 0.05 units/hour to 30 units/hour . Information from the pump can be uploaded to online registries allowing providers to review trends and usage. It is imperative the information is reviewed concurrently with glucose monitoring results in order to ensure appropriate dosing and treatment .The intervention considered in this systematic review is the use of continuous glucose monitoring (CGM) in conjunction with a CSII. CGM utilises a sensor placed in the interstitial subcutaneous tissue, which then measures glucose levels. This is accomplished with "electrochemical sensors that use glucose oxidase and measure an electric current generated when glucose reacts with oxygen. The sensors are coated with a specialised membrane to make them biocompatible" . The CGM has programmable high and low levels to alert the user when the limit is being reached. Information regarding continuous glucose levels can then be downloaded and reviewed. Based on the report, providers, patients, and caregivers may assess trends and consider changing basal rates or bolus doses .CGM sensors currently do not offer a closed-loop solution. The user must enter insulin dosing information into the pump, taking into account the present glucose level and duration of action of the insulin. Currently, CGMs are regarded as a supplemental method for assessing the effectiveness of glucose control. Existing studies are underway to improve accuracy and communication between the sensor and insulin pump with the goal to develop an artificial pancreas . Currently, CGM sensors must be calibrated with a glucometer, as specified by the manufacturer .The comparison for this review is the standard of care, self-glucose monitoring (SGM), in patients with insulin pumps . SGM is accomplished with a glucometer and blood sample typically obtained from a finger prick. The Diabetes Control and Complications Trial (DCCT) demonstrated frequency of monitoring improves glycemic control and decreases the risk of comorbidity . Data from this significant study continues to contribute to current diabetes management. According to the ADA, children and adolescents should monitor their blood glucose at least three or more times per day. Blood glucose data is utilised to calculate appropriate insulin doses. Similar to the CGM, information from the glucometers can be downloaded for assessment of results and trends. However, the result is dependent on the action of the patient to obtain the sample and only represents a specific moment in time whereas the CGM sensor continuously tracks the blood glucose level. Depending on the model, CGM can provide glucose levels every one to ten minutes. The sensor may last for up to 72 hours and results are available in real time .This systematic review will address two metabolic outcomes: a decrease in the number of hypoglycemic episodes and a haemoglobin A1C level <7.5%. These outcomes were chosen due to their significance as indicators in the management of type 1 diabetes. Glucose levels should be between 90 mg/dL and 130 mg/dL (5.0mmol/l and 7.2mmol/l) before meals and between 90 mg/dL and 150 mg/dL at night (5.0mmmol/l and 8.3mmol/l) . Optimal care of an adolescent with type 1 diabetes mellitus is to safely maintain glycemic control and avoid hypoglycemia.Haemoglobin A1C is an indicator of how well the disease is being managed and should be evaluated every three months. McCulloch recommends the haemoglobin A1C level should be compared to approximately 50 recent blood glucose readings to ensure the accuracy of patient SGM . The reliability and validity of this test is based on the evidence discovered by the DCCT demonstrating those with lower haemoglobin A1C levels have fewer complications . The target A1C for adolescents, aged 13 to 19 years of age, is <7.5% . This is consistent with the National Institute of Clinical Excellence (NICE) and diabetes management guidelines of the Australasian Paediatric Endocrine Group for the Department of Health and Ageing .An initial search for a systematic review regarding insulin pumps in adolescents with type 1 diabetes mellitus and concurrent use of CGM was conducted in the Joanna Briggs Institute Library of Systematic Reviews, Cochrane Database of Systematic Reviews, and PubMed. No systematic reviews were found.
PubMed: 27820140
DOI: 10.11124/jbisrir-2012-170 -
Clinical Nutrition (Edinburgh, Scotland) Jun 2007Total parenteral nutrition (TPN) is a lifesaving therapy in patients with severe intestinal failure that can be administered at home. However, patients have to face... (Review)
Review
BACKGROUND
Total parenteral nutrition (TPN) is a lifesaving therapy in patients with severe intestinal failure that can be administered at home. However, patients have to face complex technological nutritional support issues at home, which will influence their personal life.
OBJECTIVES
This review aims to describe the implications of home parenteral nutrition (HPN) on the quality of life, as experienced by patients, as well as to describe the caregiver's reactions regarding these notions.
SEARCH STRATEGY
A systematic review of the literature published between 1965 and 2005 was conducted. Cinahl, Medline, and Psychlit databases were searched. Systematic data extraction and narrative data synthesis were performed.
SELECTION CRITERIA
Papers were included if they described original research published in a peer reviewed journal, with a focus on adult patients on HPN and/or their family caregivers. DATA COLLECTION (AND ANALYSIS): A standardised record was used for data extraction.
MAIN RESULTS
A total of 26 studies were included. The quality of life reported by patients was moderate to good, but psychological problems, e.g. depression and anxiety, were common. Social life was disturbed due to the venous access device, the time schedule for HPN administration, the inability to have normal oral intake, gastrointestinal mobility problems, and physical complaints. Frequently mentioned somatic problems included fatigue, diarrhoea, pain, polyuria during infusion and sleep disruption. Despite social restrictions, depression and fatigue, caregivers reported their overall QoL as similar to the norms for healthy populations.
CONCLUSION
Patients on HPN meet a broad range of problems. Apart from the well-known metabolic and infectious complications, many of these are psychological or social in nature.
Topics: Caregivers; Depression; Fatigue; Humans; Parenteral Nutrition, Home; Quality of Life; Social Adjustment; Social Behavior
PubMed: 17161888
DOI: 10.1016/j.clnu.2006.10.002 -
The Cochrane Database of Systematic... Oct 2006Polydipsia is the intake of more than three litres of fluids per day. Primary polydipsia occurs when excessive drinking cannot be explained by an identified medical... (Review)
Review
BACKGROUND
Polydipsia is the intake of more than three litres of fluids per day. Primary polydipsia occurs when excessive drinking cannot be explained by an identified medical condition, and is not secondary to polyuria. The prevalence of this problem in psychiatric inpatients has been estimated at between 6 and 17%. It can hinder standard care and be a highly disabling, even life-threatening condition.
OBJECTIVES
To review the effect of pharmacological interventions for the treatment of psychosis-related polydipsia.
SEARCH STRATEGY
We searched the Cochrane Schizophrenia Group's Register (January 2002 and February 2005) which is compiled by up-to-date methodical searches of BIOSIS, The Cochrane Library, CINAHL, Dissertation abstracts, EMBASE, LILACS, MEDLINE, PSYNDEX, PsycINFO, RUSSMED and Sociofile and is supplemented with hand searching of relevant journals and numerous conference proceedings. References of all identified studies were also searched for further trials.
SELECTION CRITERIA
We included all randomised controlled trials involving people with a psychotic illness and secondary polydipsia, which evaluated drug treatments, and measured clinically meaningful outcomes.
DATA COLLECTION AND ANALYSIS
Working independently, we inspected citations, ordered papers, and then re-inspected and quality assessed the studies and extracted data. For homogeneous dichotomous data, we calculated the relative risk (RR), 95% confidence interval (CI), and, where appropriate, the number needed to treat (NNT) and the number needed to harm (NNH), on an intention-to-treat basis. We assumed that people who left the study early or who were lost to follow-up had no improvement. We calculated weighted mean differences (WMD) for continuous data. We excluded data if loss to follow-up was greater than 50%.
MAIN RESULTS
We identified two small trials (Alexander 1991 and Nishikawa 1996) which fulfilled the inclusion criteria, (total n=17, duration 3-6 weeks). Few data were reported and, because of inappropriate use of crossover methodology, we could not include all of the data in this review. For the few chronically ill people in these trials, neither the 'active' tetracycline bacteriostatic agent, oral demeclocycline, nor the opiate antagonist naloxone, nor placebo, gave any suggestion of serious adverse effects for a period of up to six weeks. The studies did not report any useful data on measures of polydipsia, physical symptoms secondary to increased fluid intake, mental state, general functioning or economic outcomes.
AUTHORS' CONCLUSIONS
The trials offer little useful data to the clinician hoping to treat psychosis-related polydipsia with drugs, except that further evaluative studies need to be conducted in this area. Treatment of any sort for psychosis related polydipsia might only be informative within a well designed, conducted and reported randomised study. The two pioneering studies suggest that larger trials, though difficult, would not be impossible with adequate support and co-ordination.
Topics: Drinking; Humans; Psychotic Disorders
PubMed: 17054176
DOI: 10.1002/14651858.CD003544.pub2 -
Acta Obstetricia Et Gynecologica... Oct 2004To perform a systematic review of the effects of estrogen therapy on symptoms suggestive of overactive bladder (OAB) in postmenopausal women. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review of the effects of estrogen therapy on symptoms suggestive of overactive bladder (OAB) in postmenopausal women.
MATERIALS AND METHODS
This analysis involved a literature review of Medline, Excerpta Medica, and the Science Citation Index and a manual search of popular urology, gynecology, gerontology, and primary care medicine journals from January 1969 to December 1999. Articles had to include estrogen and placebo treatment groups, published or original data presented at a scientific meeting and report symptoms suggestive of OAB. This search identified 11 randomized trials and included a total of 430 subjects. Thirty-six subjects who participated in two crossover studies received both estrogen and placebo and thus are counted twice, therefore 236 received estrogen therapy and 230 were placebo controls. Estrogen was administered systemically or locally as estriol, estradiol, conjugated estrogen, or estradiol and estriol. A meta-analysis of these studies was performed for all estrogen therapies and then separately for systemic and local therapies.
RESULTS
Overall, estrogen therapies were associated with statistically significant improvements in all outcome variables: diurnal frequency (P = 0.0011), nocturnal frequency (P = 0.0371), urgency (P = 0.0425), number of incontinence episodes (P = 0.0002), first sensation to void (P = 0.0001), and bladder capacity (P = 0.0018). Local therapies had statistically significant beneficial effects on all outcome variables. However, systemic therapies were only associated with significant improvements in incontinence episodes and first sensation to void while nocturnal frequency actually worsened.
CONCLUSION
Estrogen therapy may be effective in alleviating the symptoms suggestive of OAB. Local administration may be the most beneficial route of administration.
Topics: Cross-Over Studies; Estradiol; Estriol; Estrogen Replacement Therapy; Estrogens; Estrogens, Conjugated (USP); Female; Humans; Polyuria; Postmenopause; Randomized Controlled Trials as Topic
PubMed: 15453881
DOI: 10.1111/j.0001-6349.2004.00581.x -
The Cochrane Database of Systematic... 2002Polydipsia is the intake of more than three litres of fluids per day. Primary polydipsia occurs when excessive drinking cannot be explained by an identified medical... (Review)
Review
BACKGROUND
Polydipsia is the intake of more than three litres of fluids per day. Primary polydipsia occurs when excessive drinking cannot be explained by an identified medical condition, and is not secondary to polyuria. The prevalence of this problem in psychiatric inpatients has been estimated at between 6 and 17%. It can hinder standard care and be a highly disabling, even life-threatening condition.
OBJECTIVES
To review the effect of pharmacological interventions for the treatment of psychosis-related polydipsia.
SEARCH STRATEGY
The reviewers searched the Cochrane Schizophrenia Group's Register (January 2002) which is compiled by up-to-date methodical searches of BIOSIS, The Cochrane Library, CINAHL, Dissertation abstracts, EMBASE, LILACS, MEDLINE, PSYNDEX, PsycINFO, RUSSMED and Sociofile and is supplemented with hand searching of relevant journals and numerous conference proceedings. References of all identified studies were also searched for further trials.
SELECTION CRITERIA
All randomised controlled trials involving people with a psychotic illness and secondary polydipsia, which evaluated drug treatments, and measured clinically meaningful outcomes.
DATA COLLECTION AND ANALYSIS
Reviewers, working independently, inspected citations, ordered papers, and then re-inspected and quality assessed the studies. They also worked independently to extract data. For homogeneous dichotomous data, the relative risk (RR), 95% confidence interval (CI), and, where appropriate, the number needed to treat (NNT) and the number needed to harm (NNH), were calculated on an intention-to-treat basis. Reviewers assumed that people who left the study early or were lost to follow-up had no improvement. Weighted mean differences (WMD) were calculated for continuous data. Data was excluded if loss to follow-up was greater than 50%.
MAIN RESULTS
The reviewers identified two trials which fulfilled the inclusion criteria, (total n=17, duration 3-6 weeks). Few data were reported and, because of inappropriate use of crossover methodology, it could not all be used in this review. For the few chronically ill people in these trials, neither the 'active' tetracycline bacteriostatic agent, oral demeclocycline, nor the opiate antagonist naloxone, nor placebo, gave any suggestion of serious adverse effects for a period of up to six weeks. The two small studies did not report any useful data on measures of polydipsia, physical symptoms secondary to increased fluid intake, mental state, general functioning or economic outcomes.
REVIEWER'S CONCLUSIONS
The trials offer little to the clinician hoping to treat psychosis-related polydipsia with drugs, except that further evaluative studies need to be conducted in this area. Treatment of any sort for psychosis related polydipsia might only be informative within a well designed, conducted and reported randomised study. The two pioneering studies suggest that larger trials, though difficult, would not be impossible with adequate support and co-ordination.
Topics: Drinking; Humans; Psychotic Disorders
PubMed: 12137700
DOI: 10.1002/14651858.CD003544 -
The Cochrane Database of Systematic... 2001Although lithium has been the most commonly used maintenance treatment in bipolar disorder for several decades, valproate is being used increasingly - especially in the... (Review)
Review
BACKGROUND
Although lithium has been the most commonly used maintenance treatment in bipolar disorder for several decades, valproate is being used increasingly - especially in the United States of America. There is a need to clarify whether the increasingly prominent prophylactic role of valproate in bipolar disorder is justified.
OBJECTIVES
To review the effectiveness of valproate, relative to placebo, other mood stabilisers and antipsychotics, in the prevention and/or attenuation of acute episodes of bipolar disorder. The effectiveness of valproate was considered in terms of mood symptoms, mortality, general health, social functioning, adverse effects and overall acceptability to patients.
SEARCH STRATEGY
The CCDAN group search strategy was used. The following databases were searched: The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), The Cochrane Controlled Clinical Trials Register (CCCTR), EMBASE, MEDLINE, LILACS, PsycLIT and Psyndex. Reference lists of relevant papers and major textbooks of mood disorder were examined. Authors, other experts in the field and pharmaceutical companies were contacted for knowledge of suitable published or unpublished trials.
SELECTION CRITERIA
Randomised controlled trials which compared valproate with placebo, alternative mood stabilisers (including lithium and carbamazepine) or neuroleptics, where the stated intent of intervention was the maintenance treatment of bipolar disorder. Participants were males and females of all ages with a diagnosis of bipolar disorder however diagnosed, approximating to ICD 10 Code F31 and DSM IV 296, but including patients diagnosed as ICD-9 manic depressive psychosis and DSM-III and DSM-IIIR bipolar disorder.
DATA COLLECTION AND ANALYSIS
Data were extracted from the original reports individually by two reviewers. The main outcomes to be assessed were: 1. The effectiveness of valproate treatment in preventing or attenuating further episodes of bipolar disorder, including its effectiveness in rapid cycling disorder. 2. The acceptability of valproate treatment to patients. 3. The prevalence of side-effects. 4. Mortality on valproate treatment. Outcomes concerning relapse/recurrence were analysed excluding data from discontinuation studies, which were to be analysed separately. Sub-group analyses were to be performed to examine the effects of valproate treatment in rapid cycling bipolar disorder and previous mood stabiliser non-responders. Data were analysed using Review Manager version 4.1.
MAIN RESULTS
One trial of 12 months duration with 372 participants was identified comparing lithium, divalproex and placebo. It had several methodological limitations. The primary analysis of time to occurrence of mood episode described in the main trial report found no reliable difference between the treatments, although there was a trend for divalproex to be more effective than lithium. In the analysis in this review, patients taking divalproex who left the study because of the occurrence of an mood episode were significantly less in number than those on placebo (RRR 37%; RR 0.63; 95% CI 0.44 to 0.90). There was no significant difference in the numbers of patients in receipt of divalproex compared with those in receipt of lithium who left the study because they suffered any mood episode. (RRR 22%; RR 0.78; 95% C.I. 0.52 to 1.17). There was insufficient information to allow sub-group analyses of rapid-cycling disorder. The divalproex group had significantly more patients suffering tremor (RRI 223%; RR 3.23; 95% C.I. 1.85 to 5.62), weight gain (RRI 187%; RR 2.87; 95% C.I. 1.34 to 6.17) and alopecia (RRI 143%; RR 2.43; 95% C.I. 1.05 to 5.65) than the placebo group. In comparison with the lithium, divalproex was associated with more frequent sedation (RRI 58%; RR 1.58; 95% C.I. 1.08 to 2.32) and infection (RRI 107%; RR 2.07; 95% C.I. 1.16 to 3.68), but less suffered thirst (RRR 62%; RR 0.38; 95% C.I. 0.18 to 0.81) and polyuria (RRR 57%; RR 0.43; 95% C.I. 0.22 to 0.82).
REVIEWER'S CONCLUSIONS
In view of the equivocal findings of this review, conclusions about the efficacy and acceptability of valproate compared to placebo and lithium cannot be made with any degree of confidence. With current evidence, patients and clinicians would probably wish to use lithium before valproate for maintenance treatment. At present, the observed shift of prescribing practice to valproate is not based on reliable evidence of efficacy
Topics: Antimanic Agents; Bipolar Disorder; Humans; Lithium; Randomized Controlled Trials as Topic; Valproic Acid
PubMed: 11687047
DOI: 10.1002/14651858.CD003196 -
BMJ (Clinical Research Ed.) Jul 2000To quantify efficacy and harm of pharmacological prevention of acute mountain sickness. (Review)
Review
OBJECTIVE
To quantify efficacy and harm of pharmacological prevention of acute mountain sickness.
DATA SOURCES
Systematic search (Medline, Embase, Cochrane Library, internet, bibliographies, authors) in any language, up to October 1999.
STUDY SELECTION
Randomised placebo controlled trials.
DATA EXTRACTION
Dichotomous data on efficacy and harm from 33 trials (523 subjects received 13 different interventions, 519 a placebo).
DATA SYNTHESIS
At above 4000 m the mean incidence of acute mountain sickness with placebo was 67% (range 25% to 100%); incidence depended on the rate of ascent, but not on the altitude or the mode of ascent. Across all ascent rates, dexamethasone 8-16 mg prevented acute mountain sickness (relative risk 2.50 (95% confidence interval 1.71 to 3.66); number needed to treat (NNT) 2.8 (2.0 to 4.6)), without evidence of dose responsiveness. Acetazolamide 750 mg was also efficacious (2.18 (1.52 to 3.15); NNT 2.9 (2.0 to 5.2)), but 500 mg was not. In two trials, adverse reaction (including depression) occurred after dexamethasone was stopped abruptly (4.45 (1.08 to 18); NNT 3.7 (2.5 to 6.9)). With acetazolamide, paraesthesia (4.02 (1.71 to 9.43); NNT 3.0 (2.0 to 6.0)) and polyuria (4.24 (1.92 to 9.37); NNT 3.6 (2.5 to 6.2)) were reported. Data were sparse on nifedipine, frusemide (furosemide), dihydroxyaluminium-sodium, spironolactone, phenytoin, codeine, phenformin, antidiuretic hormone, and ginkgo biloba.
CONCLUSIONS
At above 4000 m, with a high ascent rate, fewer than three subjects need to be treated with prophylactic dexamethasone 8-16 mg or acetazolamide 750 mg for one subject not to experience acute mountain sickness who would have done so had they all received a placebo. Acetazolamide 500 mg does not work.
Topics: Acetazolamide; Acute Disease; Altitude Sickness; Calcium Channel Blockers; Confidence Intervals; Dexamethasone; Diuretics; Glucocorticoids; Humans; Nifedipine; Randomized Controlled Trials as Topic; Risk
PubMed: 10915127
DOI: 10.1136/bmj.321.7256.267