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). Mount Kilimanjaro, the highest peak in Africa, presents unique challenges due to its altitude zones and the associated risks of acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE). Understanding these risks and how to mitigate them is crucial for a safe and successful climb.
Kilimanjaro’s Altitude Zones
Lower Slopes (800–1,800 meters)
Environment: Lush rainforest with abundant oxygen.
Risks: Minimal altitude-related risks.
Heath and Moorland (1,800–4,000 meters)
Environment: Thinner air; vegetation becomes sparse.
Risks: Mild AMS symptoms (headache, nausea, fatigue) may begin.
Alpine Desert (4,000–5,000 meters)
Environment: Harsh, dry conditions with significantly less oxygen.
Risks: Increased likelihood of AMS, HAPE, or HACE.
Summit Zone (5,000–5,895 meters)
Environment: Extreme altitude with freezing temperatures and low oxygen levels.
Risks: Severe AMS, HAPE, or HACE can occur; immediate descent is often necessary.
Risk Categories for Developing AMS
The risk of AMS on Kilimanjaro is high due to the rapid ascent profile of most treks. Fixed itineraries and commercial pressures often limit opportunities for proper acclimatization. Key symptoms include headache, sleeping problems, and fatigue or weakness.
1. LOW-Risk 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 slow elevation gains (<1,600 ft/≈500 m per day) and extra acclimatization days.
Recommendations: Acetazolamide prophylaxis is generally not indicated.
2. MODERATE-Risk Categories
People with a prior history of AMS ascending to 8,200–9,200 ft (≈2,500–2,800 m) in 1 day.
People with no history of AMS ascending to >9,200 ft (2,800 m) in 1 day.
All people ascending >1,600 ft (≈500 m) per day above 9,900 ft (3,000 m), with extra acclimatization days.
Recommendations: Acetazolamide prophylaxis is beneficial and should be considered.
3. HIGH-Risk Categories
People with a history of AMS ascending to >9,200 ft (≈2,800 m) in 1 day.
People with a prior history of HAPE or HACE.
People ascending to >11,400 ft (≈3,500 m) in 1 day.
People ascending >1,600 ft (≈500 m) per day above 9,800 ft (≈3,000 m) without acclimatization days.
People making very rapid ascents (e.g., <5-day ascent of Kilimanjaro).
Recommendations: Descent is urgent and mandatory. Administer oxygen or use a portable hyperbaric chamber if descent is not immediately possible.
Prevention and Treatment
Acclimatization:
Ascend slowly, ideally gaining <1,600 ft (≈500 m) per day above 9,800 ft (≈3,000 m).
Include rest days every 3,300 ft (1,000 m) for acclimatization.
Medications:
Acetazolamide (Diamox): Helps prevent and treat AMS by speeding up acclimatization.
Dexamethasone: Used for severe AMS or HACE.
Nifedipine: Used for HAPE prevention and treatment.
Immediate Actions for Severe AMS, HAPE, or HACE:
Descent: The most effective treatment for severe altitude illness.
Oxygen: Administer supplemental oxygen if available.
Portable Hyperbaric Chamber: Can be used as a temporary measure if descent is delayed.
Mild HAPE Treatment:
Patients with access to oxygen (e.g., at a high-altitude clinic) may not need to descend and can be treated with oxygen over 2–4 days at the current elevation.
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.
How to Train for Kilimanjar Altitude
1. Start with Cardiovascular Fitness
Building a strong cardiovascular base is the foundation of altitude training. Focus on activities like:
Running
Hiking
Cycling
Swimming
Aim for at least 3-5 sessions per week, gradually increasing intensity and duration.
2. Incorporate Hill and Stair Training
Kilimanjaro’s terrain is steep and uneven. Simulate these conditions by:
Hiking on hilly trails
Climbing stairs with a weighted backpack
Using a stair climber at the gym
3. Practice High-Altitude Hikes
If possible, train at higher elevations to simulate Kilimanjaro’s conditions. Look for local mountains or trails above 2,000 meters (6,500 feet). If you don’t live near mountains, consider using altitude training masks or spending time in altitude chambers.
4. Strength Training for Endurance
Strengthen your legs, core, and back to handle long days of trekking. Include exercises like:
Squats
Lunges
Deadlifts
Planks
5. Acclimatization Strategies
Proper acclimatization is key to avoiding altitude sickness. Choose a Kilimanjaro route that allows for gradual ascent, such as the Lemosho or Machame routes. During your climb, follow the “climb high, sleep low” principle to help your body adjust.
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).
What is the best way to prepare for Kilimanjaro’s altitude?
The best way to prepare is through a combination of cardiovascular training, strength exercises, and practicing at higher elevations if possible.
Can I climb Kilimanjaro without altitude training?
While it’s possible, it’s not recommended. Proper training significantly improves your chances of summiting and reduces the risk of altitude sickness.
How long does it take to acclimatize to high altitude?
Acclimatization varies by person, but most climbers need several days to adjust to altitudes above 3,000 meters (9,800 feet).
