ALTITUDE SICKNESS:

Altitude Acclimatization:

Altitude acclimatization is one of the challenges trekkers encounter when Climbing Mt.Kilimanjaro. Every year, approximately 1,000 people are evacuated from the mountain, and around 10 deaths are reported with the main cause being altitude sickness. All trekkers climbing Mt.Kilimanjaro should be familiarized with symptoms of altitude sickness.

Acute Mountain Sickness (AMS)

The atmospheric oxygen percentage at sea level is about 21%, as the altitude raises oxygen molecules per breath decreases while the percentage remains constant. At 12,000 feet (3,600 m) about 40% less oxygen molecules per breath is expected hence the body must adjust to the available oxygen, failure to this AMS is experienced. Some trekkers can experience altitude sickness at low altitude zones of 8,000 feet, but severe symptoms do occur above 12,000 feet. It is not the elevation that is taxing but the rate of ascension by trekkers is the contributing effect. There are no specific factors such as age, sex, race or physical condition that correlates with vulnerability of who may be affected by altitude sickness.

More than 75% of trekkers experience some mild AMS when at altitude above 10,000 feet (3,000 m).

There are four factors contributing to AMS:

High Altitude

Hasty Rate of Ascent

High Degree of Exhaustion

Dehydration

The main cause of altitude sickness is the speedy rate of ascending, but with moderate speed and given enough time the body is prone to adaptation with the less oxygen at a given altitude. Hence this process is commonly known as acclimatization which usually takes one to three days to normalize. Several changes take place in the body during normalization to less oxygen, these are;

The rate of respiration increases.

The body produces more red blood cells to circulate oxygen.

Pressure in pulmonary capillaries is raises, “forcing” blood into unrelated parts of the lungs.

Production of more oxygen releasing enzymes from hemoglobin to the body tissues.

AMS is very common phenomenon at high altitude and many people tend to experience a mild effect when acclimatizing. The symptoms are usually noticed between 12 and 24 hours after arrival at altitude and normally disappear within the next 48 hours. The signs and symptoms of Mild AMS include:

Headache

Nausea & Dizziness

Loss of appetite

Fatigue

Shortness of breath

Disturbed sleep

General feeling of malaise

Symptoms are likely to worsen during the night when respiratory intake decreases. Mild AMS does not hinder the normal mountaineering routines, whilst symptoms subside as the body acclimatizes which makes it easy for trekking albeit at a moderate pace.

It is highly recommended for one to promptly communicate any signs of illness to trekking teammates.

The signs and symptoms of Moderate AMS include:

Severe headache which is not relieved by medication

Nausea and vomiting, fatigue and  escalating physical weakness

Shortness of breath

Decreased co-ordination (ataxia)

Those affected are able to carry on with normal routine with difficulties although they may still be capable of walking on their own. At this stage advanced medications or descent is need to reverse the situation. It is imperative to the affected person to descend before the ataxia reaches uncontrolled point where evacuation by stretcher will be the only option.  Descending only 1,000 feet (300 m) and 24 hours at a lower altitude will result in significant improvement for the affected trekker. One is then required to remain at lower altitude until all the symptoms have subsided hence recuperation connote acclimatization has been normalized and can progress trekking.

Enduring to higher altitude while experiencing moderate AMS can escalate to death.

Severe AMS can denote an escalation of the aforementioned symptoms, these including:

Shortness of breath at rest

Inability to walk

Decreasing mental status

Fluid build-up in the lungs

A severe AMS requires one immediately to descend 2,000 feet (600 m) to a lower altitude zone. There are two serious conditions which are associated with severe altitude sickness; High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). These are experienced less frequently especially to those who are properly acclimatized. But when it occurs, it is typically in people who speedily ascend or over stay in high altitude zone. In both cases lack of oxygen may result in leakage of fluid through the capillary walls into either the lungs or the brain which is a life threatening scenario.

High Altitude Pulmonary Edema (HAPE)

HAPE results from fluid buildup in the lungs which prevents the systematic flow of oxygen. As the condition worsen the level of oxygen in the bloodstream decreases hence leading to cyanosis, impaired cerebral function, and eventual death. Symptoms of HAPE include:

Shortness of breath at rest

Tightness in the chest

Persistent cough bringing up white, watery, or frothy fluid

Marked fatigue and weakness

A feeling of impending suffocation at night

Confusion, and irrational behavior

Confusion and irrational behavior are signs that insufficient oxygen is reaching the brain. In cases of HAPE one is advisable to instantaneously descend to 2,000 feet (600 m) this is life-saving measure. Evacuation of anyone suffering from HAPE is an ultimately option to a nearby medical facility for appropriate diagnosis and a thorough treatment.

High Altitude Cerebral Edema (HACE)

HACE is the result of the swelling of brain tissue from fluid leakage. Symptoms of HACE include:

Headache

Weakness

Disorientation

Loss of co-ordination

Decreasing levels of consciousness

Loss of memory

Hallucinations & Psychotic behavior

Coma

This condition is fatal unless the affected person instantaneously descends and, hence one suffering from HACE should be evacuated to a nearby medical facility for follow-up treatment.

Hypothermia is the body process whereby the temperature decreases, usually caused by a combination of cold and wet. Mild cases usually is signified by uncontrollable shivering, and putting on dry and warm clothes or/and get into a sleeping bag is highly advisable. This will amply normalize body temperature as severe cases are likely to be fatal. Symptoms include disorientation, lethargy, mental confusion, and definitely a coma; hence In this case rescue team should be contacted for timely and swift evacuation.

Medicine

If one has never been to altitudes above 2500 meters then it will hard to predict how one may react, as some clients get altitude sickness while others are less prone. Most people can go up to 2500m with minimal effects, it is important to be very cautious. As altitude increases there is literally less oxygen in the air, meaning that your body must adjust to having less oxygen. For example, at 3600m there is 40% fewer oxygen molecules per breath, ascending too quickly does not give your body enough time to acclimatize to this reduction in the amount of oxygen available to your body. This can lead to altitude illnesses and can be potentially serious or life threatening. Our guides are highly experienced, one must communicate any symptoms experience, felt and keenly listen and adhere to guide’s advice and instructions all times.

One may not feel hungry above 3000m, but one should try and eat. Eating Carbohydrates and Fruits and always avoid fatty foods as they are harder to digest. Drink plenty of fluids at least 3 litres of water daily and carrying enough water bottles will do a great deal. Dehydration is one of the most common reasons for failing to complete the climbing task. If one dress in layers, s/he can take off clothes before starting to sweat, thereby reducing water loss which can further reduce the energy level while on trek.

Acute Mountain Sickness (AMS) is common high altitudes (above 3000m) problem; most people will have mild symptoms which includes headache, nausea, fatigue, shortness of breath, insomnia, loss of appetite and swelling of hands and feet. Symptoms tend to exacerbate at night this can be reduced by allowing a person time to acclimatize by taking a day off while ascending, eating and drinking properly, and trying not to trek further. By walking slowly and steadily one will be less tired than being quick in each day’s trek. As long as symptoms are mild, and only minor then ascent can be continued albeit at a moderate rate.

Acclimatization Guidelines

The following are recommended for achieving acclimatization:

Pre-acclimatize prior to trekking mission by using a high altitude training system.

Stick to our “Pole, pole” (slowly, slowly) mantra as it take time to acclimatize, ascension should be on slow paces with resting intervals or  a day rest ultimately increases trekkers chance of reaching the  peak by  30%, making it  a memorable entertaining adventure

Mild exercise helps in altitude acclimatization but it is advisable not to overexert, as strenuous activity might cause HAPE.

Take slow deliberate deep breaths.

Adhering to climb high, sleep low principle, which denote  ascending to a higher altitude during the day and descending to lower altitude to spend a good night. Most routes comply with this principle and additional acclimatization strategy for hikers can be incorporated into the itinerary.

It is highly recommended for trekkers to eat enough high calories food and drink adequate water of around 4 – 5 while trekking as it will be of great help and benefit to trekkers.

It is grossly prohibited for trekkers to use tobacco, alcohol and other depressant drugs including, barbiturates, tranquillizers, sleeping pills and opiates, their intake adversely affects the respiratory system which will definitely trigger altitude sickness.

After perceiving symptoms of moderate altitude sickness it is advisable to discontinue to higher altitude until symptoms fade, and if there is persistent then descending is recommended.

Our guides are all experienced in detecting and treating symptoms related to altitude sickness. They will always regularly monitor trekkers by keeping close surveillance. A Pulse Oximeter test is carried out twice daily to individual trekkers to measure their body oxygen saturation and pulse rate.

It is general expected for all trekkers to be active, honest and open to the guide in the mission in case of anything for swift reaction and remedy, shyness and masking of any signs or symptom may lead to disorientation of the entire trekking team.

If there is a probability for one to abandon the trekking mission, then the guide’s advice will be crucial to determine when to descend, which is normal an order and not a request. The guide’s decision is final. It is unethical to persuade a guide with words, threats or money to continue with the mission. Guide’s decision should be respected as his ultimate goal is successful reaching the summit by taking care of one’s wellbeing and not compromising trekker’s health, hence jeopardize client’s life.

Pulse Oximeter

A Pulse Oximeter is a medical device that measures the oxygen level in the blood and pulse rate. The Oximeter used in Kilimanjaro is placed on a climber’s fingertip. The Oximeter uses two beams of light that shine into small blood vessels and capillaries in the finger. The sensor reflects the amount of oxygen in the blood. Oxygen saturation is a measurement of oxygen presence in the blood carried by the body in relation to the maximum percentage, which the normal blood oxygen levels at sea level is 95-100%

Diamox

Diamox (generic name Acetazolamide) is an F.D.A. approved drug for the prevention and treatment of AMS. The medication acidifies the blood, which causes an increase in respiration, thus accelerating acclimatization. Diamox does not disguise symptoms of altitude sickness, it prevents it. Studies have shown that Diamox at a dose of 250 mg every eight to twelve hours before and during rapid ascent to altitude results in fewer and/or less severe symptoms of acute mountain sickness (AMS). The medicine should be continued until you are below the altitude where symptoms were noticed. Side effects of Acetazolamide include tingling or numbness in the fingers, toes and face, taste alterations, excessive urination; and rarely, blurring of vision. These will fade when the medicine is stopped. It is a personal choice of the climber whether or not to take Diamox as a preventative measure against AMS. We neither advocate nor discourage the use of Diamox by trekkers.

Ibuprofen

Ibuprofen can be used to relieve altitude induced headaches

Bottled Oxygen

It is a recommended precaution and additional safety measure to carry bottled oxygen in all of climbing for use in emergency situations. It is NOT used to assist clients who have not adequately acclimatized on their own to climb higher. The immediate remedy for moderate and serious altitude sickness is descending, which in Kilimanjaro’s routes it is easily done in swift paces. Therefore, oxygen is used to strictly treat a stricken climber where necessary, juxtaposition with descending to treat moderate and severe altitude sickness. It is known that some operators market the use of supplementary personal oxygen systems as a means to curb AMS symptoms. Administering oxygen in this manner and purpose endanger one‘s life as it is temporary remedy for altitude sickness. Upon the cessation of using oxygen the client will feel the reaction, which is greater than the one felt on higher altitude without proper acclimatization.

 It is against the principles and ethical spirit of Mt.Kilimanjaro mountaineering companies to offer supplementary Oxygen, as 99% of them prohibits the use due to its potentially danger.  The main challenge of the mountaineering is reaching the summit at a high elevation, and adapting to lower oxygen levels at high altitude.

Gamow Bag

The Gamow Bag is portable hyperbaric chamber used to treat AMS. This inflatable bag is a remedy which helps clients descending to lower altitude zones. The patient is hence placed inside the bag and it is inflated with air to increase the concentration of oxygen. A Gamow bag weighs about 12 lbs and 7 feet long and 2 feet in diameter when full inflated. At 9,800 feet (3,000 m), the Gamow Bag can simulate an altitude of 4,800 feet (1,500 m). After two hours in the bag, the person’s body chemistry will be normalized as in the lower altitude. This acclimatization lasts for up to 12 hours outside of the bag which should be enough time to reach a lower altitude for acclimatization. (to do away with)

 Use of a Gamow bag in Mount Kilimanjaro is impractical, but rather optional because descending is swiftly hence the most instantaneous and recommended remedy.