How To Avoid Altitude Sickness
What is Altitude sickness?
Altitude sickness is not uncommon on Mount Kilimanjaro, also known as the Roof of Africa in Tanzania, and the highest peak in Africa, and tallest freestanding peak in the world! Towering at an incredible 5895m above sea level, climbing this majestic mountain has its challenges. The most common of them all? Altitude sickness. Altitude sickness on Kilimanjaro and your overall safety on the mountain go hand in hand, and should be taken very seriously. In this article we cover the effects of enduring high altitudes, what to expect and how to overcome it.
Altitude sickness, also called Acute Mountain Sickness (AMS), hypobaropathy and soroche, is an illness caused by exposure to the low air pressure, especially low partial pressure of oxygen, which many climbers experience at high altitudes.
AMS is caused by exerting yourself at high altitudes, especially if you have not been properly acclimatised. It is most common at altitudes above 2400 metres. Kilimanjaro’s peak is nearly 6000 metres above sea level. At this height, the air pressure (and the amount of oxygen it contains) is less than half that at sea level, and has been said to be comparable to ‘working with only one lung’.
AMS can be serious, especially as it can be debilitating, and it generally occurs far from places where medical treatment can be easily administered.
Not everyone suffers from AMS, of course, and it is very difficult to predict who is or is not vulnerable to it. Generally speaking, a fit person is less vulnerable than an unfit person, because their cardiovascular system can operate at low pressures longer without as much strain. Even so, anyone can be vulnerable at altitudes above 3500 metres, no matter their fitness level, if they have not spent some time getting used to the low atmospheric pressures first.
1. Walk high, sleep low. It is best to gradually climb higher each day, then descend lower to sleep. This lets you gradually become accustomed to lower pressures, and then recover somewhat overnight.
2. Slow and steady. You need to keep your respiration rate low enough to maintain a normal conversation. If you are panting or breathing hard, you must slow down. Overworking your heart and lungs substantially increases your chance of becoming ill.
3. Drink much more water than you think you need. Proper hydration helps acclimatisation dramatically. You need to drink at least three litres each day. As dehydration presents many of the same symptoms as altitude sickness, your chances of being allowed to continue are best if you stay hydrated.
4. Diamox. The general consensus of the research is that Diamox is helpful in avoiding AMS. We use it when climbing Kilimanjaro. We recommend you google Diamox and its effects yourself. It is a prescription drug, and you should consult with your doctor before taking it.
Effects of exposure to low atmospheric pressure
1. Low oxygen saturation
At high altitudes and low pressures, each breath takes in less oxygen, and transfers less to the blood. Blood with low levels of oxygen is said to be poorly saturated. Having slightly low oxygen saturation can lead to fatigue and feeling breathless. Severe low oxygen saturation can cause impaired mental functions, reduce your decision making ability, and have other dangerous effects. All our guides have pulse-oxymeters to check your oxygen saturation daily.
2. Cerebral oedema
Severely reduced air pressure can cause fluid to collect in the sinuses and air cavities in the skull. Initially it presents as a mild headache, but can eventually cause disorientation, coma and even death. Cerebral oedema can present very suddenly, and is an extremely serious medical issue.
3. Pulmonary oedema
This is caused by reduced air pressure in the lungs. Fluid sometimes begins to seep from the lung tissues into the air spaces of the lungs, making breathing even more difficult. This often presents like pneumonia, and is most likely to occur during sleep.
How to recognise AMS
AMS does not present as a slow, gradual worsening of lesser altitude-related symptoms like breathlessness or headache. It is in fact generally a rapid, dramatic onset of symptoms that can render a person unable to walk or take care of themselves at all.
Our guides are trained to recognise AMS and apply the appropriate first aid. They will monitor your blood oxygen saturation and evaluate your overall acclimatisation, but it is vital that you monitor and report your condition accurately, for everyone’s safety.
Our client descent protocol
If our guides believe you may be in poor health or that allowing you to continue the climb may be dangerous, they will require you to begin your descent immediately. If that decision is made, it will be according to this protocol:
Measuring your oxygen saturation
If it is below 80%, then you will be required to submit to another test every half hour, for the next two hours. If your saturation does not rise to at least 75%, you will be required to descend immediately. If your saturation is at least 75%, you will be allowed to continue subject to close monitoring. If your condition worsens you must notify your guide immediately, and begin the descent
What are the symptoms of mild altitude sickness?
Most high altitude sickness symptoms are very normal when climbing Kilimanjaro. They are generally mild and appear a few hours after moving to higher altitudes. Altitude sickness symptoms have been likened to experiencing a bad hangover and are generally worse at night when respiratory drive is decreased. Mild forms of altitude sickness may include experiencing:
- sleep disturbance
- shortness of breath with physical exertion
- loss of appetite
- nausea and vomiting
- muscle aches
- swelling of the hands, feet, and face
- a rapid heartbeat
The occurrence of altitude sickness is dependent upon the elevation, the rate of ascent, and individual susceptibility. Everyone acclimatises at different rates. The symptoms usually start 12 to 24 hours after arrival at altitude. They generally begin to decrease in severity around the third day.
How to treat mild symptoms
- acetazolamide to prevent and treat high altitude sickness
- ibuprofen and paracetamol for headaches
- anti-sickness medication, like promethazine, for nausea
There are also natural remedies you can try for treating mild symptoms of altitude sickness on Kilimanjaro. These include ginger, lavender oil, garlic and cloves. Please remember that mild altitude symptoms are to be expected. They do not interfere with normal activity and symptoms generally subside as the body acclimatises. As soon as you acclimatise, you will feel better with no lasting side effects. This means you can carry on with your climb.
What are severe symptoms?
It is very rare that a climber will experience anything more than the common mild altitude sickness symptoms listed above. However, it is important for your Kilimanjaro safety that you are aware of all possibilities. If left untreated, severe symptoms of altitude sickness can be fatal. This is why it is so important to communicate your symptoms if you are feeling unwell. If you experience a severe case of altitude sickness you may experience symptoms such as:
- wet coughing
- chest congestion
- extreme fatigue
- fast, shallow breathing
- gurgling breaths
- blue or grey lips or fingernails
- pale complexion and skin discolouration
- inability to walk or lack of balance (ataxia)
- social withdrawal
It’s important for your safety that you be aware of all possibilities.
What are HAPE and HACE?
If severe symptoms of altitude sickness are ignored, they can lead to life-threatening conditions affecting the brain or lungs. This is considered severe altitude sickness. There are two serious conditions associated with severe altitude sickness:
- High altitude pulmonary edema (HAPE), which is a build-up of fluid in the lungs
- High altitude cerebral edema (HACE), which is the swelling of the brain caused by a lack of oxygen
These conditions are very rare. But when they do occur, it’s usually because you went too high too quickly and stayed at that height. In both HAPE and HACE, the lack of oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain.
HAPE symptoms and treatment
The symptoms of HAPE include a blue tinge to the skin (cyanosis), breathing difficulties (even when resting), tightness in the chest, a persistent cough, bringing up pink or white frothy liquid (sputum), tiredness and weakness.
HAPE treatment includes moving down to a lower altitude immediately, taking nifedipine (helps to reduce chest tightness and ease breathing), and using bottled oxygen.
HACE symptoms and treatment
HACE symptoms include headache, weakness, nausea and vomiting, loss of coordination, feeling confused, and hallucinations.
HACE treatment includes moving down to a lower altitude immediately, taking dexamethasone (a steroid medication that reduces swelling of the brain), and using bottled oxygen.