Attitude sickness guide for Kilimanjaro climbs

What is Kilimanjaro Altitude Sickness?

Altitude sickness occurs when your body doesn’t acclimatize properly to the reduced oxygen levels at high altitudes. Symptoms can range from mild to severe and typically appear above 2,500 meters (8,200 feet).

Symptoms of Altitude Sickness

1. 1. Mild Symptoms (AMS):

      • Headache

      • Nausea or vomiting

      • Dizziness

      • Fatigue

      • Shortness of breath

      • Loss of appetite

      • Difficulty sleeping.

Severe Symptoms (HAPE or HACE):

High Altitude Pulmonary Edema (HAPE): Fluid in the lungs, causing coughing, chest tightness, and extreme fatigue.

High Altitude Cerebral Edema (HACE): Swelling of the brain, causing confusion, loss of coordination, and hallucinations.

Kilimanjaro’s Altitude Zones

1. Lower Slopes (800-1,800 meters): Lush rainforest with abundant oxygen.

2. Heath and Moorland (1,800-4,000 meters): Thinner air; mild AMS symptoms may begin.

3. Alpine Desert (4,000-5,000 meters): Harsh, dry conditions with significantly less oxygen.

4. Summit Zone (5,000-5,895 meters): Extreme altitude; risk of severe AMS, HAPE, or HACE.

Risk categories for developing acute mountain sickness (AMS)

The most common high altitude symptoms were headache, followed by sleeping problems and fatigue or weakness. The incidence of AMS is high among trekkers climbing Mount Kilimanjaro. The main reason for this seems to be rapid ascent. Kilimanjaro treks normally have a fixed timetable, and for commercial reasons there is little opportunity to spend extra days for acclimatization in the camps. Some contributing factors are preventable.

Risky  LOW Categories

• People with no prior history of altitude illness ascending to <9,000 ft (2,750 m)
• People taking ≥2 days to arrive at 8,200–9,800 ft (≈2,500–3,000 m), with subsequent increases in sleeping elevation <1,600 ft (≈500 m) per day, and an extra day for acclimatization every 3,300 ft (1,000 m) increase in elevation

RECOMMENDATIONS

Acetazolamide prophylaxis is generally not indicated

Risky MODERATE Categories

• People with a prior history of AMS and ascending to 8,200–9,200 ft (≈2,500–2,800 m) elevation (or suffer 1 day)
• People with no history of AMS ascending to >9,200 feet (2,800 m) elevation in 1 day
• All people ascending >1,600 ft (≈500 m) per day (increase in sleeping elevation) at elevations >9,900 ft (3,000 m), but with an extra day for acclimatization every 3,300 ft (1,000 m)

RECOMMENDATIONS

Acetazolamide prophylaxis would be beneficial and should be considered

Risky HIGH Categories

• People with a history of AMS ascending to >9,200 ft (≈2,800 m) in 1 day
• All people with a prior history of HAPE or HACE
• All people ascending to >11,400 ft (≈3,500 m) in 1 day
• All people ascending >1,600 ft (≈500 m) per day (increase in sleeping elevation) at elevations >9,800 ft (≈3,000 m), without extra days for acclimatization
• People making very rapid ascents (e.g., <5-day ascent of Mount Kilimanjaro)

Treatment

In most circumstances, descent is urgent and mandatory. Administer oxygen, if available, and exert the patient as little as possible. If immediate descent is not an option, the use of supplemental oxygen or a portable hyperbaric chamber is critical.

Patients with mild HAPE who have access to oxygen (e.g. at a hospital or high-elevation medical clinic) might not need to descend to a lower elevation and can be treated with oxygen over 2-4 days at the current elevation.

Tips to help you prevent altitude sickness while Climbing Mount Kilimanjaro:

1. Choose a Longer Route

• Why: Longer routes (7-9 days) allow your body more time to acclimatize to the altitude.

• Recommended Routes: Lemosho, Machame, or Northern Circuit.

• Avoid Shorter Routes: Routes like Marangu (5-6 days) increase the risk of altitude sickness due to rapid ascent.

2. Ascend Slowly (Pole Pole)

• Why: A slow pace gives your body time to adjust to decreasing oxygen levels.

• Tip: Follow your guide’s pace and avoid rushing, even if you feel strong.

3. Climb High, Sleep Low

• Why: This strategy helps your body adapt to higher altitudes by exposing it to elevation during the day and returning to a lower altitude to sleep.

• Example: On some routes, you’ll hike to a higher elevation during the day and descend slightly to camp at night.

4. Stay Hydrated

• Why: Dehydration worsens altitude sickness symptoms.

• Tip: Drink 3-4 liters of water daily. Avoid alcohol and caffeine, as they can dehydrate you.

5. Eat Well

• Why: Proper nutrition provides energy and helps your body function at high altitudes.

• Tip: Eat high-carbohydrate meals and snacks, even if you don’t feel hungry.

6. Take Diamox (Acetazolamide)

• Why: Diamox helps prevent and treat mild altitude sickness by speeding up acclimatization.

• Tip: Consult your doctor before the climb to see if Diamox is right for you. If prescribed, start taking it 1-2 days before your ascent.

7. Listen to Your Body

• Why: Early detection of altitude sickness symptoms can prevent them from becoming severe.

• Tip: Report any symptoms (headache, nausea, dizziness) to your guide immediately.

8. Avoid Overexertion

• Why: Overexertion can increase the risk of altitude sickness.

• Tip: Pace yourself, take breaks, and avoid pushing too hard, especially on steep sections.

9. Sleep Lower if Symptoms Appear

• Why: Descending even a few hundred meters can significantly improve symptoms.

• Tip: If you feel unwell, inform your guide and consider sleeping at a lower altitude.

10. Train and Prepare Physically

• Why: Being in good physical condition reduces the strain on your body at high altitudes.

• Tip: Focus on cardiovascular fitness, strength training, and hiking with a weighted pack before your climb.

11. Avoid Alcohol and Sleeping Pills

• Why: Both can depress your breathing, making it harder for your body to adjust to altitude.

• Tip: Stay away from alcohol and sleeping pills during the climb.

12. Monitor Oxygen Levels

• Why: Low oxygen saturation can indicate poor acclimatization.

• Tip: Some guides carry pulse oximeters to monitor oxygen levels. If your levels drop significantly, take action.

13. Be Prepared to Descend

• Why: Descending is the most effective treatment for severe altitude sickness.

• Tip: Don’t let summit fever override your safety. If symptoms worsen, descend immediately.

14. Acclimatization Days

• Why: Extra days at intermediate altitudes help your body adjust.

• Tip: Choose routes with built-in acclimatization days, such as Lemosho or Northern Circuit.

15. Know the Symptoms of Altitude Sickness

• Mild Symptoms (AMS):

  • Headache

  • Nausea

  • Dizziness

  • Fatigue

• Severe Symptoms (HAPE or HACE):

  • Confusion

  • Difficulty breathing

  • Loss of coordination

  • Coughing up fluid

16. Travel with a Reputable Guide

• Why: Experienced guides know how to pace the climb, recognize altitude sickness symptoms, and respond to emergencies.

• Tip: Choose a tour operator with a high success rate and well-trained guides.

17. Mental Preparation

• Why: A positive mindset can help you push through challenges.

• Tip: Stay focused, motivated, and prepared for the physical and mental demands of the climb.

How to Prevent High-Altitude Problems on Kilimanjaro

Climbing Mount Kilimanjaro, which reaches an elevation of 5,895 meters (19,341 feet), exposes climbers to high-altitude environments where the air is thinner and oxygen levels are significantly lower. This can lead to high-altitude problems, including altitude sickness and other related issues. Here’s a detailed overview of the high-altitude problems you might encounter on Kilimanjaro and how to manage them:

1. Acute Mountain Sickness (AMS)

• What it is: The most common high-altitude problem, caused by the body’s inability to acclimatize to reduced oxygen levels.

• Symptoms:

  • Headache

  • Nausea or vomiting

  • Dizziness

  • Fatigue

  • Loss of appetite

  • Difficulty sleeping

• Prevention/Treatment:

  • Ascend slowly.

  • Stay hydrated.

  • Take Diamox (acetazolamide) as a preventive measure.

  • Descend if symptoms worsen.

2. High Altitude Pulmonary Edema (HAPE)

• What it is: A life-threatening condition where fluid builds up in the lungs, preventing oxygen exchange.

• Symptoms:

  • Severe shortness of breath, even at rest.

  • Coughing, sometimes with pink or frothy sputum.

  • Chest tightness or congestion.

  • Extreme fatigue and weakness.

• Prevention/Treatment:

  • Descend immediately.

  • Use supplemental oxygen if available.

  • Seek emergency medical attention.

3. High Altitude Cerebral Edema (HACE)

• What it is: A severe and potentially fatal condition where fluid builds up in the brain, causing swelling.

• Symptoms:

  • Confusion or disorientation.

  • Loss of coordination (ataxia).

  • Severe headache that doesn’t respond to medication.

  • Hallucinations or changes in behavior.

  • Unconsciousness (in advanced stages).

• Prevention/Treatment:

  • Descend immediately.

  • Use supplemental oxygen.

  • Administer dexamethasone (a steroid) if available.

  • Seek emergency medical help.

4. Dehydration

• What it is: High altitude and physical exertion can lead to rapid fluid loss.

• Symptoms:

  • Dry mouth and throat.

  • Dark urine or reduced urination.

  • Fatigue and dizziness.

• Prevention/Treatment:

  • Drink 3-4 liters of water daily.

  • Avoid alcohol and caffeine.

5. Hypothermia

• What it is: A dangerous drop in body temperature, often caused by cold weather at high altitudes.

• Symptoms:

  • Shivering.

  • Slurred speech.

  • Confusion.

  • Loss of coordination.

• Prevention/Treatment:

  • Dress in layers and use proper cold-weather gear.

  • Stay dry and avoid sweating excessively.

  • Seek shelter and warm up if symptoms occur.

6. Frostbite

• What it is: Freezing of skin and underlying tissues, often affecting extremities like fingers, toes, nose, and ears.

• Symptoms:

  • Numbness or tingling.

  • Skin turning white or grayish-yellow.

  • Hard or waxy-looking skin.

• Prevention/Treatment:

  • Keep extremities warm and dry.

  • Use insulated gloves, socks, and face protection.

  • Seek medical attention if frostbite occurs.

7. Exhaustion

• What it is: Physical and mental fatigue caused by the strenuous climb and high altitude.

• Symptoms:

  • Extreme tiredness.

  • Difficulty concentrating.

  • Weakness.

• Prevention/Treatment:

  • Pace yourself and take regular breaks.

  • Eat high-energy foods.

  • Stay hydrated.

8. Sleep Disturbances

• What it is: Difficulty sleeping at high altitudes, often caused by periodic breathing (Cheyne-Stokes respiration).

• Symptoms:

  • Waking up frequently.

  • Shortness of breath during sleep.

• Prevention/Treatment:

  • Use Diamox to reduce periodic breathing.

  • Practice good sleep hygiene (e.g., warm sleeping bag, comfortable sleeping pad).

Medications used for Altitude sickness on Kilimanjaro:

Altitude sickness (Acute Mountain Sickness or AMS) is a common concern for climbers on Mount Kilimanjaro due to the rapid ascent to high altitudes. While proper acclimatization is the best way to prevent altitude sickness, medications can play a supportive role. Here’s a guide to the medications used for altitude sickness on Kilimanjaro:

1. Acetazolamide (Diamox)

• What it is: The most commonly used medication for preventing and treating mild altitude sickness.

• How it Works:

  • Stimulates breathing to increase oxygen intake.

  • Helps the body acclimatize faster by reducing fluid retention.

• Uses:

  • Prevention: Start taking Diamox 1-2 days before your ascent and continue for the first 2-3 days at high altitude.

  • Treatment: Can be used to treat mild AMS symptoms.

• Dosage:

  • Prevention: 125-250 mg twice daily.

  • Treatment: 250 mg twice daily.

• Side Effects:

  • Tingling in fingers, toes, or face.

  • Increased urination.

  • Altered taste (especially for carbonated drinks).

  • Rarely, more severe side effects like allergic reactions.

• Important Notes:

  • Consult your doctor before using Diamox.

  • Not a substitute for proper acclimatization.

2. Dexamethasone

• What it is: A steroid used to treat severe altitude sickness, particularly High Altitude Cerebral Edema (HACE).

• How it Works:

  • Reduces brain swelling and inflammation.

• Uses:

  • Treatment: For severe AMS or HACE symptoms (e.g., confusion, loss of coordination).

  • Not for Prevention: Dexamethasone is not used to prevent altitude sickness.

• Dosage:

  • 4 mg every 6 hours for treatment.

• Side Effects:

  • Increased blood sugar.

  • Mood changes.

  • Stomach irritation.

• Important Notes:

  • Only for emergency use.

  • Must be combined with immediate descent.

3. Nifedipine

• What it is: A medication used to treat High Altitude Pulmonary Edema (HAPE).

• How it Works:

  • Reduces pressure in the lungs, helping to clear fluid buildup.

• Uses:

  • Treatment: For HAPE symptoms (e.g., severe shortness of breath, coughing up fluid).

  • Not for Prevention: Nifedipine is not typically used to prevent altitude sickness.

• Dosage:

  • 30 mg slow-release tablet every 12 hours.

• Side Effects:

  • Low blood pressure.

  • Dizziness.

  • Headache.

• Important Notes:

  • Only for emergency use.

  • Must be combined with immediate descent and supplemental oxygen.

4. Ibuprofen

• What it is: A non-steroidal anti-inflammatory drug (NSAID) used to treat headaches, a common symptom of AMS.

• How it Works:

  • Reduces inflammation and pain.

• Uses:

  • Symptom Relief: For mild AMS headaches.

  • Not for Prevention: Ibuprofen does not prevent altitude sickness.

• Dosage:

  • 400-600 mg every 6-8 hours as needed.

• Side Effects:

  • Stomach irritation.

  • Increased risk of bleeding.

• Important Notes:

  • Use only for symptom relief, not as a substitute for acclimatization or descent.

5. Anti-Nausea Medications

• Examples: Ondansetron or promethazine.

• What it is: Medications to relieve nausea and vomiting, which are common symptoms of AMS.

• Uses:

  • Symptom Relief: For nausea or vomiting caused by altitude sickness.

• Important Notes:

  • These medications treat symptoms but do not address the underlying cause of altitude sickness.

Key Takeaways

• Diamox (Acetazolamide) is the most effective medication for preventing and treating mild altitude sickness on Kilimanjaro.

• Dexamethasone and Nifedipine are used for severe altitude sickness (HACE and HAPE) but are not for prevention.

• Ibuprofen and anti-nausea medications can help relieve symptoms but do not prevent or treat the root cause of altitude sickness.

• Medications should be used in conjunction with proper acclimatization, hydration, and descent if symptoms worsen.

Important Reminders

1. Consult a Doctor: Always consult your healthcare provider before taking any medication for altitude sickness.

2. Not a Substitute for Acclimatization: Medications can help, but they are not a replacement for proper acclimatization and a slow ascent.

3. Emergency Plan: If symptoms of severe altitude sickness (HAPE or HACE) occur, descend immediately and seek medical attention.

Best Acclimatization for Climbing Kilimanjaro

Acclimatization is one of the most critical factors for a successful and safe climb of Mount Kilimanjaro. Proper acclimatization helps your body adjust to the decreasing oxygen levels at high altitudes, reducing the risk of altitude sickness (Acute Mountain Sickness or AMS) and other high-altitude problems. Here’s everything you need to know about acclimatization on Kilimanjaro:

Why Acclimatization is Important

• Kilimanjaro’s summit, Uhuru Peak, stands at 5,895 meters (19,341 feet), where oxygen levels are about half of those at sea level.

• Without proper acclimatization, climbers can experience symptoms of altitude sickness, ranging from mild headaches to life-threatening conditions like High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE).