How To Prevent Altitude Sickness When Climbing Kilimanjaro

Preventing Altitude Sickness is a key factor to success when trying to climb Mount Kilimanjaro.

But what is Altitude sickness? What are the symptoms? And how can you avoid it! This guide will hopefully answer all of those questions and more!

Altitude Sickness – “I’m really fit, I’ll be OK, won’t I?”

Not necessarily. Everybody responds to altitude differently and unfortunately if you have not been at altitude before you will not know how you will cope! I have been cycling at 4650m above sea level in Bolivia and believe me that was hard work! I definitely was not prepared despite being at 3500m for 3 weeks previous. Thankfully I was OK at these altitudes, but many suffer Acute Mountain sickness, or even worse High Altitude Pulmonary Oedema (HAPE), and High Altitude Cerebral Oedema (HACE). You might be forgiven for thinking that I’d be ok on a Kilimanjaro trek, but you’re wrong. As I do not regularly go to high altitudes there is the chance that next time I do I may not be as lucky!

What Causes Altitude Sickness? 

All humans breathe in air. The air we breathe is comprised of many different gases. One of these is oxygen. When you travel to high altitudes the amount of oxygen in the air is the same as at sea level, but the atmospheric pressure is a lot lower. This means the amount of oxygen you can absorb with each breath is less than usual. This can quite quickly lead to a drop in the body’s oxygen levels. This is called hypoxia.

When we talk about altitude sickness, whilst hypoxia or generalised hypoxia are correct terms we tend to refer to either Acute Mountain Sickness (AMS), HAPE or HACE.

What Are The Symptoms Of Altitude Sickness?

The symptoms of acute mountain sickness, HAPE and HACE all start the same but HAPE and HACE are serious complications that usually follow the onset of acute mountain sickness and the can even lead to death. You may get HAPE, HACE or even both together.

Acute Mountain Sickness – Symptoms start with a headache, and are usually accompanied by one or more of the following symptoms: lack of appetite, feeling or being sick, dizziness, problems sleeping, weakness or tiredness. Whilst these symptoms are a concern, they usually resolve if the climb is delayed by 1-3 days. This is obviously a problem with an organised Kilimanjaro trek, which is why it is so important not to rush the climb.

High Altitude Cerebral Oedema (HACE) – a serious complication of acute mountain sickness. HACE is essentially swelling, caused by fluid around the brain. This leads to confusion, difficulty remaining conscious, and co-ordination issues. Ultimately death occurs. HACE usually occurs at least 2 days after reaching heights of 3000m-4000m and is rarely seen below 2800m.

High Altitude Pulmonary Oedema – a serious complication of acute mountain sickness, but unlike HACE can occur without symptoms of mountain sickness. Symptoms of HAPE include breathlessness at rest, breathlessness when lying down, wet cough and frothy red sputum. Sputum is mucous that collects on your chest. It is likely that you will develop a wheeze and a tightness across the chest. Ultimately death occurs. HAPE usually occurs at least 2 days after reaching heights of 3000m-4000m and is rarely seen below 2800m.

What’s My Risk When Climbing Kilimanjaro Of Developing Altitude Sickness?

Unfortunately, the risk is high. The Wilderness Medicine Society categorise risk and unfortunately, Kilimanjaro treks are always high risk. The risk factors for high-risk mountain sickness are:

  • Individuals with a history of AMS ascending to ≥2,800m in one day
  • People with a history of HACE
  • Those ascending to >3,500m in one day
  • Those ascending >500 m/day (in sleeping elevation) above 3,000m without extra days for acclimatisation
  • Very rapid ascents (e.g. many treks on Kilimanjaro)

Why Are Kilimanjaro Treks Such A High risk?

As I mentioned earlier Kilimanjaro treks do not allow a sufficient amount of time to ensure acclimatisation. Altitude guidelines state that above 3000m you should not climb and sleep any higher than 500m per day with a rest day every 3-4 days. With this in mind, it would probably take you about 8 days to climb from 3000m to the Summit and none of the standard Kilimanjaro treks are this long. As mentioned before always opt for one of the longer treks as you have the greatest chance of getting to the summit. 

How Do I Treat Altitude Sickness?

Your guides on a Kilimanjaro trek will be the difference between getting to the top and not getting to the top! They will provide a lot of assistance and help. Symptoms of acute mountain sickness can be managed by doing the following:

  • Avoid smoking
  • Eat light meals
  • Avoid alcohol
  • Treat the headache with Ibuprofen or Paracetamol
  •  Drink plenty of water

Hopefully, your body adjusts to the conditions quickly and with suitable rest periods and a good night’s sleep you may be fit to carry on climbing!

Unfortunately, the only real treatment for altitude sickness is to go back down again! We cannot stress enough that continuing to push on through obvious signs of altitude sickness that are getting progressively worse can be very dangerous!!

What Can I Do To Maximise The Chance Of Reaching The Summit?

Apart from the obvious, like ensuring you are physically and mentally prepared and have chosen a trek that is sufficiently long enough I would advise that you seriously consider using acetazolamide, also known as Diamox.

What Is Acetazolamide?

Acetazolamide is a tablet that belongs to a group of medicines known as Carbonic Anhydrase inhibitors. They are normally used for the treatment of glaucoma but these days more frequently used to prevent altitude sickness symptoms.

How Does Acetazolamide Work?

These tablets work by increasing the removal of bicarbonate (an alkali) from the body, this causes the body to become slightly acidic. To counter this the body naturally elevates your breathing rate to correct this problem which also allows you to breathe in more oxygen allowing you to acclimatise quicker when going to high altitudes.

How Do I take Acetazolamide (Diamox) If Climbing Kilimanjaro?

For prevention of Acute Mountain Sickness, Acetazolamide needs to be started one or two days before starting your trek and until you reach the summit. Usually a dose of either half a tablet (125mg) twice day or one tablet (250mg) twice a day is sufficient. A typical climb taking 5 days would require a minimum of 5 tablets, how Travelpharm would recommend a trial course before travel of several days to ensure you tolerate the medicine before getting to Tanzania. This means we reckon you should buy around 14 tablets to ensure you can trial them before you fly and have sufficient for your climb at 250mg twice daily.

Acetazolamide is NOT a substitute for a gradual climb and it will not always prevent you from getting altitude sickness. However, you only get one go at climbing Kilimanjaro so maximise the opportunity.

What Are Side Effects Of Acetazolamide (Diamox)?

Problematic side effects are rarely reported, but of the ones that are the most troublesome side effect is usually painful tingling of fingers and toes. This is a side effect that won’t just disappear on its own, but the tingling will stop once you finish the medicine. It is not a dangerous side effect but the sensation can be very uncomfortable and Travelpharm would advise all climbers to discontinue using the medicine if it gets to this stage.

It is also a weak diuretic, which means you may need to go for a wee more often. Do not worry about this, but it means that you must stay properly hydrated when trekking! Watch the colour of your wee, if it starts to get too yellow you are not drinking enough!

Other commonly reported adverse events include:

  •  Skin rashes
  • Drowsiness
  • Taste disturbances
  • Dizziness
  • Fatigue
  • Flushing
  • Sensitivity to sunlight (rarely reported but travel to high altitude areas increases exposure to UV radiation so sun protection should be worn on the body, face and lips.)

As with all medicines, it is really important that you read the patient information leaflet before using the medicine.

Who Can’t Take Acetazolamide?

  • People who are allergic to the active ingredient or those who are allergic to the group of drugs called Sulphonamides.
  • If you have unbalanced blood salts, ie sodium and potassium levels not correct
  • Those suffering from kidney or liver disease

Climbers who suffer from depression should take particular care as acetazolamide has been linked to suicidal behaviour, but there is insufficient data to draw a thorough conclusion. So in these scenarios, Acetazolamide can be used, but with caution.

Can I Buy Diamox Over The Counter?

Acetazolamide (Diamox) is, unfortunately, a prescription-only medicine and so it is not available to buy over the counter. However, you can buy this medicine from fully regulated online pharmacies like Travelpharm who employ a specialist prescriber. This cuts out a trip to see your GP, who by the way is not usually a specialist in travel medicine, which means you save time, money and effort!

At Travelpharm we sell Acetazolamide tablets as single tablets meaning you only order what you need for your climb. We don’t even charge hidden fees, like admin or prescription fees. The only fee we charge is delivery and even that’s FREE with orders over £29.

Click the links below to find out more about:

Everything You Need To Know About Climbing Kilimanjaro (Read More)

Anti-Malaria Prevention (Read More)

Walking/Trekking First Aid (Read More)

Staying Hydrated Safely (Read More)

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