Acute Mountain Sickness or Altitude Sickness is a major concern when climbing Kilimanjaro. The permit system on Kilimanjaro, where the national park charges per day rather than per climb encourages operators to offer shorter itineraries in order to be competitive on price. This means that on shorter itineraries full acclimatisation will not be possible and even on longer itineraries a large proportion of people climbing Kilimanjaro will suffer from mild symtoms of Acute Mountain Sickness. If you have any pre-existing health conditions that you think may make you more susceptible to AMS we recommend that you consult your doctor before booking this trip.

How to minimise your chances of suffering from altitude sickness on Kilimanjaro:

There are a number of practical steps that you can take to minimise the chances of having to abondon your climb of Kilimanjaro due to the effects of altitude sickness:

• Acclimatise prior to the climb. Easier said than done if you live at sea level but if you are able to spend time at high altitude prior to the actual Kilimanjaro climb then this is the very best way to avoid altitude sickness. Climbing Mount Meru prior to Kilimanjaro is also an excellent option.
• Start the climb in the best possible health and with an excellent level of physical fitness. If you are fatigued, unwell or stressed you are more likely to suffer from altitude sickness.
• Take it easy on the trail and in camp. You will get sick of your guides telling you to Pole, Pole, but they are right! If you overdo it by pushing too hard you are likely to pay for it later.
• Drink plenty of fluids. Getting up in the middle of the cold night may be an unpleasant thought but altitude dehydrates you and the better you hydrate the quicker your body is able to acclimatise. (You should also avoid all alcohol)
• Eat well. Even though you may not feel like it you should eat as much as you possibly can at every meal. This will give you plenty of energy and help you to feel great. I find it also helps me to keep warm and sleep well at night.
• Sleep well.  Sleeping well in a tent is an acquired skill. Spend a few nights out in your tent and sleeping bag prior to your climb so that you have your routine nailed and are used to sleeping in a sleeping bag on a hard surface.
• Relax. Relax and think positive. Although not pleasant the vast majority of people suffer only mild altitude sickness (which is like a hangover). Don't think that every headache is cerebral oedema and every cough pulmonary oedema as this is unlikely. By relaxing and enjoying the climb you are far more likely to have a trouble free experience.

The Golden Rules

The Cause

All including the physically fit can get acute mountain sickness during rapid ascent if staying more than 12 hours above 2500m. The altitude difference undergone in 24 hours is the determining factor. From 3000 metres and higher, the risk increases when the altitude difference between encampments exceeds 300 metres.

The Symptoms

Many climbers on Kilimanjaro will experience the early symptoms of Altitude Sickness which include headaches, nausea, dizziness, breathlessness, loss of appetite and possibly palpitations.  DO NOT ASCEND IF YOUR SYMTOMS FAIL TO IMPROVE.  DESCEND IF SYMTOMS GET WORSE AT THE SAME ALTITUDE. If vertigo, vomiting, apathy, staggering and breathlessness occur, immediate accompanied descent is essential. Failing to descend may be fatal.

Prevention

Avoid ascents of greater than 300 metres per day if starting from above 3000 metres (these are the guidelines for trekking in high mountain areas and this is normally impossible to achieve on Kilimanjaro). If early signs of mountain sickness appear, rest for a day at the same altitude. If they persist or increase, descend at least 500 metres. Acetazolamide (Diamox) can be used to help prevent mountain sickness when a gradual ascent cannot be guaranteed. It should NOT be used as an alternative to a gradual ascent. It acts on acid-base balance and stimulates respiration. It should be combined with a good fluid intake. It should not normally be used in young children except under close medical supervision. Dose: 125 mg to 250mg twice daily for adults. It should be started 24 hours before ascent and continued only for the first 2 days at high altitude while acclimatisation occurs.

Treatment

Initially simple analgesia (e.g. ibuprofen) for headaches. Sleeping pills should be avoided if possible. Acute Mountain Sickness with Cerebral Oedema - Immediate evacuation or descent at least 1000 metres; oxygen if available. Dexamethasone (12-20 mg daily) or Prednisolone (40 mg daily). Acetazolamide 250 mg orally within 24 hours of onset of symptoms and 250mg orally 8 hours later. High Altitude Pulmonary Oedema - Immediate evacuation or descent. If symptoms are acute and/or descent is impossible or delayed consider Nifedipine (20mg tds).

Further Information on AMS:

If you are worried please don’t hesitate to give one of our experienced team a call as we have all trekked at altitude and experienced some degree of AMS at one time or another. Your guide book also has a substantial section devoted to Altitude Sickness which we recommend you read through carefully. Further information is available online: https://www.nhs.uk/conditions/altitude-sickness/ 

Disclaimer:

This post in no way constitutes medical advice and you should always consult your doctor prior to undertaking and expedition at high altitude. This is simply a few useful hints, tips and guidelines that have served me well trekking and climbing at high altitude.

Comments:

If you have any advice on how to minimise the effects of AMS I would really like to hear your comments.