Altitude Sickness/Acute Mountain Sickness
If you are planning to climb Mount Kilimanjaro you will sooner or later hear about altitude sickness.
For those unfamiliar with the ins and outs of altitude illness, here are answers to the most common questions regarding mountain sickness.
What is Altitude Sickness?
Symptoms associated with altitude sickness result from the body's inability to adjust to lower levels of oxygen in the blood. At sea level, the concentration of oxygen is about 21% and the barometric pressure averages 760 mmHg. As altitude increases, oxygen concentration remains the same but the number of oxygen molecules per breath is reduced due to lower barometric pressure. At 3,658 meters (12,000 feet), barometric pressure decreases to 483 mmHg, resulting in roughly 40% fewer oxygen molecules per breath. In order to increase oxygen levels in the blood, your body responds by breathing faster. Although oxygen levels increase, sea level concentrations cannot be reached. The body must adjust to having less oxygen. This adjustment is called acclimatization. At elevations above 5,500 meters, acclimatization is not possible and the body begins to deteriorate.
The main cause of altitude sickness is going too high too fast. Given enough time, your body will adapt to the decrease in oxygen at a specific altitude. This process is known as acclimatization and generally takes one to three days at any given altitude. Upon climbing to a higher elevation, the body must readjust to the new altitude again over a period of one to three days.
In order to cope with decreased oxygen levels, the body reacts in the following ways:
•Respiration frequency and depth increases
•Pressure in pulmonary arteries is increased, "forcing" blood into portions of the lung which are normally not used during sea level breathing.
•Additional red blood cells are produced to carry oxygen
•Enzymes are produced to facilitate the transfer of oxygen from hemoglobin to body tissues.
It is imperative that hikers be aware of symptoms of Acute Mountain Sickness during Kilimanjaro and Meru trips and that they communicate with the guide regularly regarding their condition. It is very important to rest and not ascend further if experiencing severe symptoms of AMS.
Above 3,000 meters (9,842 feet), most people experience a periodic breathing during sleep known as Cheyne-Stokes Respirations. The pattern begins with a few shallow breaths and increases to deep sighing respirations then falls off rapidly for a few seconds before shallow breathing begins again. During the period when breathing stops the person often becomes restless and may wake with a sudden feeling of suffocation. This can disturb sleeping patterns, exhausting the climber. This type of breathing is not considered abnormal at high altitudes. Diamox is helpful in relieving this periodic breathing.
Acute Mountain Sickness (AMS)
Acute Mountain Sickness is common at high altitudes and 75% of people experience some symptoms over 3,000 meters (9,842 feet). The severity of AMS depends on several factors including rate of ascent, elevation, and individual susceptibility. Symptoms usually begin between 12 and 24 hours after reaching altitude and decrease in severity by the third day.
Mild AMS symptoms include: headache, nausea and dizziness, loss of appetite, fatigue, shortness of breath, and inability to sleep.
As long as the symptoms are mild, hikers can continue to climb at a moderate rate. All symptoms of AMS should be communicated to the head guide and progress reports should be given daily.
Moderate AMS symptoms include: severe headache, nausea and vomiting, increased weakness and fatigue, shortness of breath, and decreased coordination.
Although the hiker may be able to continue walking on their own while experiencing moderate symptoms of AMS, normal activity becomes more and more difficult as the hiker gains altitude. At this stage, only medicine and descent can reverse the symptoms of AMS. Even a minor descent of only 300 meters will result in a significant improvement. All symptoms of moderate AMS should be communicated to the guide at which point the guide will make a decision whether or not to evacuate. Depending on symptoms, the climber may be told to walk a straight line. If he or she is not able to walk a straight line on their own, immediate descent is required.
Severe AMS symptoms include: increased shortness of breath, loss of ability to walk, decreasing mental awareness, and fluid buildup in lungs.
Severe AMS can only be treated by immediate descent to lower altitudes.
Other Severe Altitude-Related Illnesses
Two other severe forms of altitude sickness may result from failure to descend to lower altitudes. These include High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE). Although these happen less frequently, they usually result from fast ascents among people who are not properly acclimatized. The lack of oxygen in the body causes a leakage of fluid through the capillary walls into either the lungs or brain.
High Altitude Pulmonary Edema (HAPE)
HAPE results from fluid buildup in the lungs and can prevent effective oxygen exchange. Impaired cerebral function, cyanosis, and death may result in severe cases of HAPE. Symptoms of HAPE include: shortness of breath even at rest; fatigue and weakness; feeling of impending suffocation or drowning; grunting or gurgling sounds when breathing; persistent cough which brings up white, watery, or frothy fluid; confusion and irrational behavior. In cases of HAPE, immediate descent is necessary. Patients should be evacuated to a medical facility for follow-up treatment.
High Altitude Cerebral Edema (HACE)
HACE is the result of swelling of brain tissue from fluid leakage. Symptoms include the following: headache; loss of coordination (ataxia); weakness; decreasing levels of consciousness including, disorientation, loss of memory, hallucinations, blindness, and coma. HACE generally occurs after a week or more at high altitude. Severe instances can lead to death if not treated quickly and immediate descent is a necessary life-saving measure. Follow-up care must be sought at a medical facility following HACE.
Preventing Altitude Sickness
There are two ways to prevent altitude-related illness: proper acclimatization and preventative medicines. These recommendations are written specifically for climbing Mounts Meru and Kilimanjaro in Tanzania and may not be applicable to other high mountains. But always Summit Odyssey advise our climbers to have a ‘polepole ’pace and drinking plenty of water as the best preventative method to slow down the altitude sickness.
•Tell guide your AMS symptoms and keep him as well as the other group members informed of your progress.
•Climb high and sleep low. It is recommended that you acclimate during the day by climbing to high elevations and then descending to sleep.
•If you begin to show symptoms of moderate altitude illness, don't go higher until symptoms decrease.
•If symptoms become severe, descend.
•Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 4-6 liters per day). Urine should be clear.
•Don't over-exert yourself at altitude. Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
•Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. Depressants further decrease the rate of respiration during sleep resulting in a worsening of the symptoms.
•Eat a high calorie diet of which 70% is carbohydrates.
Diamox (Acetazolamide): Diamox is a drug that allows you to breathe faster so that you metabolize more oxygen. Although gradual ascent is recommended as opposed to Diamox, the drug does help to avert symptoms of Altitude Mountain Sickness. Because it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommended dose is between 125 mg and 250 mg twice daily starting one to two days before the trek and continuing for three days once the highest altitude is reached. Possible side effects include tingling of the lips and finger tips, excessive urination, blurring of vision, and alteration of taste. Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies. (There are other medications that may be taken to prevent altitude sickness. You must ask your doctor if they are right for you.)
Ibuprofen relieves altitude induced headache.
Nifedipine rapidly decreases pulmonary artery pressure and also seems able to decrease the narrowing in the pulmonary artery caused by low oxygen levels, thereby improving oxygen transfer. It can therefore be used to treat HAPO, though unfortunately its effectiveness is not anywhere as dramatic that of dexamethasone in HACO. The dosage is 20mg of long acting nifedipine, six to eight hourly.
Frusemide may clear the lungs of water in HAPO and reverse the suppression of urine brought on by altitude. However, Frusemide can also lead to collapse from low volume shock if the victim is already dehydrated. Treatment dosage is 120mg daily.
Common Simple Problems During Your Kilimanjaro Trekking
A common outdoor complaint, headaches have three general courses: 1) dehydration, 2) muscular tension, and 3) a vascular disorder. Most headaches respond to rest, hydration, massage and over-the-counter painkillers, e.g. ibuprofen. Beware of the headache that comes on suddenly, is unrelieved by rest and medication, and it not like any other headache you have ever had.
Lean the patient forward and pinch the meaty part of the nose firmly shut. Hold it for 10 to 15 minutes. If bleeding persists, a squirt of a nose spray, such as Afrin, may help stop the bleeding. If the bleeding still persists, pack the nostrils gently with gauze soaked with antibiotic ointment or a spray such as Afrin. It is possible for noses to bleed from the back, and blood runs down the throat.
Six to twelve hours after overexposure to the sun’s radiation, the patient complains of pain and swelling in the eye with a feeling like an “eye full of sand”. The cornea of the eye has been sunburned. Sunburned eyes are usually very sensitive to light. Rinses with cool water will clean the eye and ease the pain. Cool compresses may be applied for pain. A small amount of antibiotic ointment may be applied several times a day for two to three days. Ointments made for the eye are best. The patient’s eyes may need to be covered for 24 hours. Snow blindness almost always resolves harmlessly in 24 to 48 hours. Prolonged discomfort is reason to see a physician. The problem can be prevented by water; sunglasses should fit well and have side-shields to block reflected UV light.
The immediate response to overexposure to ultraviolet light is burned skin aging and degenerative skin disorders such as a cancer. First aid for sunburn includes cooling the skin, applying a moisturizer, ibuprofen for pain and inflammation, and staying out of direct sunlight. If blisters form, a doctor should be consulted. Prevention of sunburn includes hats with brims and tightly-woven clothing, sun blocks such as zinc oxide, and sunscreens with a high sun protection factor-SPF 15 or more. Be aware: You can burn on cloudy days, sunlight is most harmful between the hours of 10AM and 3PM, sunlight is most harmful between the hours of 10am and 3pm, and large amounts of UV light are reflected by snow and water.
The backcountry is home to a multitude of diarrhea-causing life forms: protozoa, bacteria, viruses. They will produce, generally speaking, one of two kinds of diarrhea:
1). Non-invasive diarrhea, with microbial colonies on upper small intestine walls, leading to abdominal cramping, nausea, vomiting, and massive amounts of water, filled with salt and potassium, rushing out of the bowels. 2). Invasive diarrhea, sometimes called dysentery, with bacteria attacking the lower small intestine and colon, causing inflammation, bloody bowel movements, fever, abdominal cramping, and painful release of loose stools.
Whatever the cause, dehydration is the immediate problem with diarrhea. Mild diarrhea can be treated with water or diluted fruit juices or diluted sports drinks. Persistent diarrhea requires more aggressive replacement of electrolytes lost in the stool. Oral dehydration solutions are best for treating serious diarrhea. You can get by, usually, adding one tsp. salt and eight tsp. sugar to a liter of water. The patient should drink about one-fourth of this solution every hour, along with all the water he or she will tolerate. Rice, grains, bananas, potatoes are OK to eat. Fats, dairy products, caffeine and alcohol should be avoided.
Over-the-counter medications for watery diarrhea are available. Prescription medications include Lomotil. Dysentery should be treated with antibiotics, not medicinal plugs.
Water is easily and quickly lost from the body in the outdoors through sweating, urination, defecation, breathings, and diarrhea. Even mild dehydration causes loss of energy, loss of mental acuity, and loss of fun. Mild dehydration shows up as thirst, dry mouth and dark urine. Moderate dehydration adds very dry mouth, reduction of the amount of dark urine, a rapid weak pulse, and remarkable dizziness when the patient stands up. Severe dehydration very very dry mouth, lack of urine, and chock. Treatment of dehydration is explained above (see Diarrhea). Prevention is this: Drink half-liter every morning. Drink a quarter-liter every 15 to 20 minutes during periods of exercise. Drink enough to keep you urine clear.
EMERGENCY MEDICAL KITS
All international travelers should carry their own first aid kit, especially trekkers who end up well away from medical assistance of any sort. Your physician will probably be willing to help you put together the hard-to-find items you will want to have along. The kit should include a brief written personal medical history including allergies and recent illnesses, and any prescription drugs you are personally using with written directions for their use a copy of the prescription. Note: If you use or think you will need an injected drug, carry your own sterile syringes. It is not safe to rely on the sterility of needles in many countries. Carry painkillers, antacids, antihistamines, anti-diarrhea medications, insect repellent, sunscreen, a means to disinfect water, wound management materials including ointment, gauze, tape and other bandages, and a few basic splinting materials. Remember a first aid kit functions only at the level of the person using it. If you really want to take of yourself and others in remote settings, pack some training into your brain.
Diamox and Altitude Sickness
Acetazolamide, or what is commonly sold under the trade name Diamox, is a drug that is used for various medical treatments – including glaucoma, sleep apnea, epilepsy and hypertension. It is also used to help mitigate the effects of altitude sickness.
Using Diamox on Kilimanjaro is a question you are going to face when you start your preparations to reach the Roof of Africa.
What is Diamox?
Diamox (aka Acetazolamide), as it is used for Acute Mountain Sickness (AMS), is a diuretic (i.e. it promotes the production of urine) and a prophylactic (i.e. is used as a preventative medicine – not a cure).
It is also a carbonic anhydrase inhibitor (ahem, what?). Essentially this means that it promotes the excretion, via urine, of bicarbonate – which is why it is useful for altitude sickness
Diamox and altitude sickness
The excretion of bicarbonate increases the acidity of the blood, as bicarbonate is a conjugate base of carbonic acid. Increased acidity in the blood is equated by our bodies as increased CO2. The body responds to the imaginary excess CO2 by breathing deeper and faster to get rid of the CO2. Deeper, faster breathing increases the amount of oxygen received by the blood. This helps with the acclimatisation process and helps prevent the onset of AMS symptoms.
Obviously you should first consult your doctor to check whether Diamox is a suitable drug given your particular medical history. It is not suitable for pregnant women or anyone with kidney or liver disease issues (obviously these people shouldn’t be climbing Kilimanjaro in the first place)
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
Typically 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.