ACCLIMATIZATION AND ALTITUDE SICKNESS ON KILIMANJARO

Mount Kilimanjaro, the highest peak on the African continent, stands at 5,895 meters (19,341 feet). Climbing Kilimanjaro presents unique challenges, with altitude sickness being one of the most significant risks. A considerable number of climbers experience symptoms related to altitude once they surpass 9,000 feet. At DareTravel Tours, your safety is our top priority

A Popular Trek with Extreme Altitude Considerations

Mount Kilimanjaro has gained significant popularity as a trekking destination, offering ordinary hikers the opportunity to reach a high mountain summit without requiring technical climbing skills. Known as a “walk-up” route, Kilimanjaro does not require ropes or specialized climbing equipment. However, this accessibility can lead some to underestimate the serious, potentially life-threatening risks associated with high altitude.

The summit of Kilimanjaro is categorized as “extreme altitude,” similar to peaks like Aconcagua and Denali (Mount McKinley). In contrast, Everest and K2 are classified as “ultra” altitude, where acclimatization is extremely challenging and often not achievable

Understanding Oxygen Levels and Altitude on Kilimanjaro

At the summit of Mount Kilimanjaro, the oxygen levels are about 49% lower than at sea level. This decrease isn’t due to a reduction in the percentage of oxygen in the air, which remains at 20.9%, but rather due to the lower barometric pressure (air pressure) at high altitudes.

In simpler terms, the same volume of air you breathe at the summit contains fewer oxygen molecules because of the reduced air pressure. This drop in air pressure can lead to serious health issues, including the accumulation of fluid around the brain (High Altitude Cerebral Edema) and the lungs (High Altitude Pulmonary Edema). Both conditions are severe and require immediate medical attention.

Understanding Mountain Sickness: AMS, HACE, and HAPE

Mountain sickness encompasses three primary forms:

  1. Acute Mountain Sickness (AMS): This is the most common type and can range from mild to severe. Mild AMS is manageable with proper treatment, while moderate and severe cases require prompt action. Severe AMS can necessitate immediate descent to prevent further complications.

  2. High Altitude Cerebral Edema (HACE): A serious condition where fluid accumulates around the brain, leading to symptoms such as confusion, hallucinations, and severe headaches. HACE requires urgent medical intervention and descent to lower altitudes.

  3. High Altitude Pulmonary Edema (HAPE): This condition involves fluid buildup in the lungs, causing difficulty in breathing, persistent cough, and extreme fatigue. HAPE is also a medical emergency requiring immediate descent and treatment.

Let’s take a closer look at these conditions.

Acute Mountain Sickness (AMS)

Overview: According to Dr. Peter Hackett of the Institute for Altitude Medicine, Acute Mountain Sickness (AMS) can impact anyone climbing above 6,000 feet. The initial symptom is often a headache, which can also be indicative of dehydration or over-exertion. If additional symptoms arise, AMS is a likely diagnosis.

Mild AMS
In its mildest form, AMS symptoms can resemble those of a hangover, including nausea, headache, fatigue, and loss of appetite. It’s crucial to inform your guide if you experience these symptoms rather than attempting to push through. Mild AMS is generally manageable with rest and adequate hydration.

Moderate AMS
As mild AMS progresses, symptoms may worsen, including persistent headaches, dizziness, coughing, shortness of breath, nausea, and vomiting. This indicates inadequate acclimatization. Immediate descent to a lower altitude where you previously felt well is recommended. Treatments like ibuprofen for headaches or anti-emetics for nausea may mask symptoms but do not address the underlying issue.

Severe AMS
If moderate AMS symptoms are ignored and the ascent continues, the condition can escalate to severe AMS, which poses life-threatening risks, including High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE). Severe AMS symptoms include intense headaches, ataxia (lack of coordination, difficulty walking), increased coughing, and shortness of breath. Immediate descent and possible evacuation by stretcher or helicopter are essential.

Severe AMS can lead to severe complications such as HAPE and HACE, both of which require urgent medical intervention.

High Altitude Pulmonary Edema (HAPE)

Basecamp MD notes that High Altitude Pulmonary Edema (HAPE) arises when the lung arteries experience increased pressure due to the low oxygen levels at high altitudes. This elevated pressure causes fluid to accumulate around the lungs.

Interestingly, climbers may develop HAPE without exhibiting severe symptoms of Acute Mountain Sickness (AMS).

Signs to Watch For:

  • Coughing Up Blood or Mucus: This may indicate fluid accumulation in the lungs.
  • Abnormal Lung Sounds: Listen for unusual sounds during breathing.
  • Extreme Listlessness: A profound sense of fatigue and weakness.
  • Difficulty Breathing: Noticeable shortness of breath.
  • Blue Lips: Cyanosis, a sign of insufficient oxygen.
  • Confusion and Lack of Coordination: Difficulty with mental clarity and physical coordination.

Anyone experiencing respiratory symptoms at high altitude should consider the possibility of HAPE until confirmed otherwise by a medical professional. If HAPE is suspected, immediate administration of oxygen and evacuation to a medical facility are essential.

As oxygen levels in the blood decrease, the brain may also suffer from insufficient oxygen, potentially leading to High Altitude Cerebral Edema (HACE).

High Altitude Cerebral Edema (HACE)

High Altitude Cerebral Edema (HACE) is a critical condition that demands urgent medical attention. It occurs when fluid accumulates around the brain, leading to severe symptoms.

Signs of HACE Include:

  • Disorientation and Confusion: The climber may experience hallucinations, disorganized thinking, and speak incoherently.
  • Lack of Coordination: Difficulty walking, staggering, and overall impaired motor skills.
  • Irrational Behavior: Unusual or erratic behavior not typical for the individual.
  • Severe Headache: Often accompanied by nausea and vomiting.

Daily Health Monitoring and the Lake Louise Scoring System

At DareTravel Tours, our guides conduct daily health checks using a pulse oximeter to monitor your oxygen saturation and pulse rate. This data, combined with your symptoms, helps our guides evaluate your condition effectively.

Lake Louise Scoring System

Introduced in 1991 and updated as recently as 2018, the Lake Louise Scoring System is a widely recognized method for assessing a climber’s health in the field. This scoring system assigns a numerical value to the severity of altitude sickness symptoms, providing a structured framework for our guides to evaluate your condition accurately.

Headache:

  • 0: No headache
  • 1: Mild headache
  • 2: Moderate headache
  • 3: Severe headache, incapacitating

Gastrointestinal Symptoms:

  • 0: Good appetite
  • 1: Poor appetite or mild nausea
  • 2: Moderate nausea or vomiting
  • 3: Severe nausea and vomiting, incapacitating

Fatigue and/or Weakness:

  • 0: No fatigue or weakness
  • 1: Mild fatigue or weakness
  • 2: Moderate fatigue or weakness
  • 3: Severe fatigue or weakness, incapacitating

Dizziness/Light-Headedness:

  • 0: No dizziness or light-headedness
  • 1: Mild dizziness or light-headedness
  • 2: Moderate dizziness or light-headedness
  • 3: Severe dizziness or light-headedness, incapacitating

AMS Clinical Functional Score:

  • 0: No impact on activities
  • 1: Symptoms present, but did not alter activity or itinerary
  • 2: Symptoms forced a halt in ascent or self-evacuation
  • 3: Required evacuation to a lower altitude

[Source: High Altitude Medicine and Biology]

Understanding Acclimatization on Kilimanjaro

Acclimatization, also known as “acclimation,” refers to the body’s natural process of adapting to the lower oxygen levels and atmospheric pressure found at high altitudes. From the moment you start your climb, your body begins to make adjustments to handle the reduced oxygen availability.

Key Changes You May Notice:

  • Deeper and Potentially Faster Breathing: Your body will increase your breathing rate to take in more oxygen.
  • Elevated Resting Heart Rate: Your heart works harder to circulate oxygen-rich blood.
  • Potentially Higher Blood Pressure: Your circulatory system adjusts to the lower oxygen levels.

Mechanisms of Adaptation:

  • Increased Hemoglobin Production: Your body produces more hemoglobin to improve oxygen transport.
  • Enhanced Erythropoietin Production: This hormone, released by the kidneys, stimulates the production of red blood cells.
  • Reduced Plasma Volume: This can lead to a higher risk of dehydration.
  • Increased Kidney Function: Your kidneys excrete excess bicarbonate ions to maintain the blood’s acid-base balance.

These adaptive processes help your body cope with the high-altitude environment, but they take time. It’s crucial to ascend gradually to allow your body to adjust properly.

The Importance of Acclimatization for a Successful Kilimanjaro Summit

Acclimatization is a gradual process, essential for ensuring a successful and safe summit on Mount Kilimanjaro. Optimal acclimatization occurs on routes that incorporate effective protocols, allowing your body ample time to adapt to the high-altitude environment.

Why Gradual Ascent Matters:

  • Extended Adaptation Time: Routes with longer, gradual ascents give your body more time to adjust to the reduced oxygen levels.
  • Incorporation of Acclimatization Days: “Hike high, sleep low” days and rest periods enhance your body’s ability to adapt, significantly reducing the risk of altitude sickness.

Individual Variability and Supportive Measures:

  • Variable Responses: While some climbers adapt easily, others may struggle. There are no shortcuts to acclimatization; it primarily depends on time.
  • Medication Support: Diamox (acetazolamide) can assist by enhancing your body’s natural acclimatization processes, potentially speeding up adaptation.

Incorporating acclimatization days and following a well-structured climb plan improves your chances of reaching the summit safely and successfully.

How to Avoid Altitude Sickness on Kilimanjaro

  • Choose a Longer Route:

    • Opt for a route that allows gradual acclimatization rather than the quickest ascent.
    • Routes like the Machame or Lemosho provide better acclimatization opportunities.

  • Hike Slowly:

    • Remember the Swahili phrase “pole pole” (slowly, slowly).
    • Avoid overexertion and be the last person into camp to conserve energy.

  • Hydration and Acclimatization:

    • Stay hydrated to help your body adjust to the altitude.
    • Dehydration can hinder acclimatization, so drink plenty of fluids.

  • Consult Your Doctor:

    • Consider using Diamox (acetazolamide) to prevent altitude sickness.
    • Consult your doctor to determine if it’s suitable for you.

  • Monitor Symptoms:

    • If you experience symptoms of altitude sickness (AMS), don’t climb higher.
    • Common symptoms include headaches, nausea, and fatigue.

  • Avoid Certain Substances:

    • Steer clear of narcotic painkillers, sleeping pills, alcohol, and stimulants.
    • These can affect your body’s ability to acclimatize.

  • Carbohydrates and Nutrition:

    • Carbohydrates are efficient fuel at high altitudes.
    • Keep eating to maintain energy levels.

  • Stay Warm and Dry:

    • Hypothermia is a risk, especially in wet clothes.
    • Dress warmly and stay dry to prevent dangerous situations.

Altitude Training: Enhancing Your Kilimanjaro Climb

Altitude training has gained popularity among aspiring mountaineers as a method to boost performance and facilitate acclimatization. Various protocols are employed to mimic high-altitude conditions and prepare the body for the challenges of climbing Mount Kilimanjaro.

Common Altitude Training Methods:

  • Simulated Altitude Chambers: Training in environments that replicate high-altitude conditions.
  • Hypoxic Tents: Sleeping in tents that simulate high-altitude air pressure.
  • Intermittent Hypoxic Exposure: Breathing hypoxic air during rest periods.

Effective Pre-Acclimatization Strategies:

  • Climbing Mt. Meru: If possible, ascending Mt. Meru before Kilimanjaro can be highly beneficial. It provides practical experience with high-altitude conditions and helps gauge your acclimatization capacity.
  • Local High Altitude Peaks: If you have access to high-altitude locations in your home country, climbing these can also be advantageous.

While these pre-acclimatization methods can be helpful, they are not essential for everyone. However, if you have the opportunity to train at altitude, it can offer valuable insights into how well you adapt to high elevations. For a detailed exploration of altitude training techniques, refer to our comprehensive guide.

Consulting Your Doctor Before Climbing Kilimanjaro

Before undertaking a climb of Mount Kilimanjaro, it’s crucial to consult your doctor to determine if your medical history might impact your ability to travel to high altitudes. While many individuals with well-managed pre-existing conditions can successfully summit Kilimanjaro, it’s essential to get personalized medical advice to ensure your safety.

Key Points to Discuss with Your Doctor:

  • Pre-existing Conditions: Share your medical history, especially conditions related to respiratory or cardiovascular health.
  • Altitude Risks: Understand how high altitude may affect your specific health conditions.
  • Travel Recommendations: Receive tailored advice on whether it is safe for you to proceed with high-altitude travel.

Your doctor’s guidance will help you assess any potential risks and ensure you’re fully prepared for a safe and successful Kilimanjaro adventure

Understanding Sleep Disturbance at Altitude

Sleep disturbances at high altitude are commonly caused by periodic breathing, which can be both uncomfortable and disruptive. According to the Institute for Altitude Medicine, this phenomenon occurs due to a conflict between the body’s oxygen and carbon dioxide sensors during sleep.

How Periodic Breathing Works:

  • Oxygen Sensors signal the body to breathe more deeply to increase oxygen intake.
  • Carbon Dioxide Sensors trigger the body to reduce breathing to prevent excessive loss of carbon dioxide.

This tug-of-war can lead to a pattern of deep breaths followed by pauses in breathing, then a deep breath as the cycle restarts.

Managing Sleep Disturbance:

  • Diamox: This medication has been shown to alleviate symptoms of periodic breathing by helping the body acclimate more effectively.

If you experience sleep issues while climbing Kilimanjaro, consulting with your guide and considering medication like Diamox may help improve your rest and overall comfort.

Proactive Health Management During Your Kilimanjaro Climb

Hypothermia

To prevent hypothermia, it is crucial to avoid staying in wet clothes, whether from rain or perspiration. As temperatures drop when you stop moving, wet clothing can quickly lead to hypothermia, especially at higher altitudes. Ensure you carry extra layers in your day pack and adjust your clothing as needed to stay dry and warm, as temperature fluctuations are common as you ascend.

Sun Protection

The sun’s rays are much harsher at high altitudes due to reduced atmospheric filtering. To protect yourself:

  • Use Sunscreen: Apply a high-factor sunscreen (SPF 40+) on all exposed skin, including your head and neck.
  • Wear Sunglasses: Choose sunglasses that block 100% of UV rays. Wraparound sunglasses are ideal to shield your eyes from UV rays reflected off glaciers and snow, reducing the risk of snow blindness, which, while not frequent, is a serious concern.

Gastrointestinal Health

Traveling to remote locations increases the risk of gastrointestinal issues due to different foods, hygiene standards, and exposure to various bacteria and viruses. To minimize risk:

  • Before the Climb: Avoid eating from street vendors, steer clear of tap water, and refrain from consuming salads or unpeeled fruit.
  • On the Mountain: We adhere to stringent food hygiene protocols and provide safe, purified water at all times. Regularly use anti-bacterial gel or wipes on your hands, especially before eating, to maintain hygiene and reduce the risk of stomach issues.

DareTravel Tours Safety Procedures

At DareTravel Tours, your safety is our top priority. Our trained guides will closely monitor your well-being throughout the climb. However, your cooperation is essential for effective safety management:

  • Inform Your Guide: If you feel unwell or experience any symptoms, notify your guide immediately.
  • Watch for Others: Pay attention to your fellow climbers. If you notice unusual behavior or signs of distress in someone, alert your guide right away.

Together, we can ensure a safer and more enjoyable climb for everyone

Each day, your guide will perform the following checks to ensure your well-being:

  • Oxygen Saturation: Your oxygen levels will be monitored using a pulse oximeter.
  • Health Assessment: You’ll be asked about how you’re feeling and any symptoms you may be experiencing.
  • Lung Sounds: Your guide will listen to your chest for any unusual sounds.

Early detection is key to preventing mild altitude sickness from progressing.

The DareTravel Tours team is equipped with emergency oxygen and portable stretchers provided by the National Park for every climb. Should a climber be unable to continue due to health issues, we have partnered with Kilimanjaro Helicopter Rescue for prompt emergency evacuation.