The pharmacotherapy of prevention and treatment of acute altitude- related problems - acute mountain sickness, high-altitude cerebral oedema and high-altitude pulmonary oedema - is reviewed. Drug therapy is only part of the answer to the medical problems of high altitude; prevention should include slow ascent and treatment of the more severe illnesses should include appropriate descent. Carbonic anhydrase inhibitors, in particular acetazolamide, remain the most effective drugs in preventing, to a large extent, the symptoms of acute mountain sickness, and can be used in the immediate management of the more severe forms of altitude-related illnesses. Glucocorticoids in relatively large doses are also effective preventative drugs, but at present are largely reserved for the treatment of the more severe acute mountain sickness and acute cerebral oedema. Calcium channel blockers and PDE-5 inhibitors are effective in the management of acute pulmonary oedema. Further work is required to establish the role of antioxidants and anticytokines in these syndromes.

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Loss of protein and reduced rates of protein synthesis are hallmarks of both gram negative sepsis and acute alcohol toxicity. Endotoxaemia, as a result of altered gut permeability, has also been reported to initiate some of the pathological lesions seen in alcoholism. We hypothesized that during alcohol exposure, endotoxin administration would further inhibit protein synthesis. To investigate this rats were treated with either endotoxin (3 mgkg; i.p.), ethanol (75 mmollkg; i.p.) or both for 3 hours. Controls were identically treated and injected with 0.15 moVl NaCl i.p. Fractional rates of protein synthesis (b, % skeletal muscle protein renewdday) were measured in skeletal muscle in vivo with[3H]phenylalanine. Data (as mean f SEM, n=5-8) were as follows: R RAJENDRAM'~, JS MARWAY', VR PREEDY'~ &TJ PETERS A single dose of 500mg Az conferred no benefit to partially acclimatised individuals, and would appear to have a temporary adverse effect on peripheral oxygen saturation.