Mountain Sickness and Precaution

High altitude trekking comes with obvious risks, Acute Mountain Sickness (AMS), High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE), are your biggest concerns.

  1. Acute Mountain Sickness (AMS) (altitude sickness or altitude illness) and its severe variants

There are three levels of Acute Mountain Sickness symptoms: mild, moderate and serious. Symptoms include:

  • Fatigue
  • Headaches
  • Nausea and Dizziness
  • Shortness of breath
  • Disturbed sleep
  • Loss of appetite

If you suffer any of the symptoms above, it is important to communicate to your climbing guide about how you are feeling. These symptoms generally disappear if you rest for a day at the level at which they originally started. This is why an acclimatization day where you climb high and sleep low is so important.

  1. High Altitude Cerebral Edema (HACE)

High Altitude Cerebral Edema (HACE), is a condition associated with severe Acute Mountain Sickness. It occurs due to swelling of the brain tissue from fluid build up in the cranium. It is a life threatening condition.

On Kilimanjaro, people suffering from HACE should descend immediately and seek medical attention when they get to the lower reaches of the mountain.

HACE can be identified if someone is suffering from the following symptoms:

  • Severe headaches which cannot be relieved by medication
  • Hallucination
  • Loss of consciousness
  • Disorientation
  • Loss of coordination (i.e. ataxia)
  • Memory loss
  • Coma

HACE tends to set in at night. Do not hang around until morning if someone in your group is suffering HACE symptoms. The longer you wait at altitude the greater the probability of fatality. Descend immediately, even under darkness. Under no circumstances should one ascend if they have suspected HACE symptoms. If you have oxygen it can be administered along with a steroid called, dexamethasone, but these should only be used in conjunction with rapid descent.

  1. High Altitude Pulmonary Edema (HAPE)

High Altitude Pulmonary Edema (HAPE) is a condition associated with Acute Mountain Sickness and occurs because of fluid build up in the lungs. Fluid in the lungs prevents the effective exchange of oxygen and thus a decrease of oxygen into the bloodstream.

HAPE almost always occurs because of ascending too high, too fast.
It is a life threatening condition and therefore every precaution should be taken to avoid it when trekking. Clear symptoms that one is suffering from HAPE include:

  • Very short of breath, even while resting
  • Very tight chest
  • The feeling of suffocation, particularly while sleeping
  • Coughing that brings up white, frothy fluid
  • Extreme fatigue and weakness
  • Confusion, hallucination and irrational behavior

 

If the last symptom occurs (i.e. confusion, hallucination and irrational behaviour) one can assume that the pulmonary edema has started to affect the brain due to a lack of oxygen in the bloodstream.

Any available oxygen should be administered. The drug, Nifedipine, has been shown to ameliorate the condition, but descent is the only cure.

Trekkers should take care to ensure that the person descending with High Altitude Pulmonary Edema doesn’t exert themselves as this can result in worsening of the condition. A stretcher evacuation is the preferred method of descent.

Kilimanjaro Altitude Zones

On Kilimanjaro there are three altitude zones – high altitude (2,500 – 3,500 metres), very high altitude (3,500 – 5,500 metres) and extreme altitude (above 5,500 metres). Most people can ascend to 2,400 meters without experiencing the negative effects of altitude. However, as one enters the high altitude zone changes in air density and available oxygen begin to impact one’s physiology. One’s susceptibility to these changes is very difficult to predict, though, as there is very little correlation to factors of gender, age, fitness etc. We do however know that going too high, too fast is the key cause of AMS. Other contributing factors are dehydration and over exertion at altitude. A proper acclimatization strategy involves not going too high, too fast whilst also ensuring you don’t overexert yourself and remain well hydrated.

How the body adapts to higher altitudes

Here’s the good news, your body is very good at adapting to changes in its environment. Given enough time your body can adapt to high altitude. Four main body changes are worth mentioning. As you ascend:

  • Breathing becomes a lot deeper and faster
  • Red blood cell count increases which allows more oxygen to be carried in the blood
  • Pressure in your pulmonary capillaries increases which forces blood into areas of the lungs that are not used when breathing at sea level
  • More of a particular enzyme is produced which causes oxygen to be released from hemoglobin to the blood tissue

It is important to remember that your body can cope at high altitude, it just needs time to acclimatize.

Guidelines

Trekking is not a very risky or dangerous adventure as long as you follow some basic guidelines.

In particular:

  • If you have a chance to pre-acclimatize before trekking Mount Kilimanjaro, do so. A good option in Tanzania is to trek the neighbouring Mount Meru (4,565 m) before attempting Kilimanjaro
  • If you are a novice high altitude trekker then choose a route itinerary that is at least seven days long (6 up, 1 down). In our opinion, the seven day Machame or 7/8 day Lemosho are the most suitable routes for the average trekker
  • Ensure the route allows for a good climb high, sleep low opportunity (both the Machame and Lemosho do)
  • When on the mountain make a point to go as slowly as possible, do not overexert yourself, even on the lower reaches
  • Drink loads of fluid (2.5-4 liters a day)
  • Do not drink alcohol, take stimulants, smoke or consume caffeine on the mountain
  • We recommend taking acetazolamide (Diamox)

As recommended by the Charity Altitude Organization, always remember these basic essential guidelines when at high altitude:

  • If you feel unwell, you have altitude sickness until proven otherwise
  • Do not ascend further if you have symptoms of altitude sickness
  • If you are getting worse then descend immediately

Preventative Medications – Diamox

Acetazolamide, or Diamox, is a drug that has been proved to be effective at mitigating altitude sickness. The drug helps to increase the acidity of the blood by acting as a diuretic and promoting urination. Increased acidity in the blood is equated by our bodies as increased CO2, and hence one starts breathing deeper and faster to get rid of the CO2. Deeper, faster breathing increases the amount of oxygen received by the blood and this helps prevent the onset of AMS symptoms.

It is important to note that Diamox is a prophylactic (preventative medicine), and does not cure the symptoms of AMS. Once altitude sickness symptoms have started, the only way to stop them is descent. Under no circumstances should Diamox be used to continue an ascent with AMS.

Diamox is also a prescription drug so it is important that you first consult your doctor to check whether it is a suitable drug given your particular medical history. It is not suitable for pregnant women or anyone with kidney or liver disease issues. We recommend taking Diamox for 2-3 days 2 weeks before departure to test whether you experience any side effects.

Typical side effects associated with Diamox are:

  • Frequent urination – everyone experiences this when taking Diamox. It can result in the development of kidney stones so it is important that you drink loads of fluids whilst taking the medication
  • Numbness and tingling in the fingers, toes and face – Many people experience this side effect when taking Diamox. The sensation is a little discomforting but not dangerous
  • Taste alterations (some foods might taste weird)
  • Nausea, vomiting and diarrhea – this is rare. These side effects should be identified during your test before departing for Kilimanjaro. Unfortunately these side effects are common with AMS and therefore can easily be misdiagnosed as AMS
  • Drowsiness and confusion is also possible – again these side effects can be confused with AMS

Diamox comes in 250mg tablets. Most people take half a tablet in the morning and half in the evening. You should start taking tablets one day before arriving in Kilimanjaro and continue taking the same dosage for all ascent days. You can cease taking Diamox on descent.