Acclimatization & Altitude Sickness

Symptoms can range from mild to severe and typically appear within 6-24 hours of ascending to high altitudes:
Mild AMS: Headache, nausea, dizziness, fatigue, loss of appetite, shortness of breath, difficulty sleeping.
Moderate to Severe AMS: Worsening of mild symptoms, vomiting, persistent headache unrelieved by medication, confusion, coordination problems, severe shortness of breath even at rest.
Life-Threatening Forms:
High Altitude Pulmonary Edema (HAPE): Fluid in the lungs, causing severe shortness of breath, coughing (sometimes with frothy sputum), chest tightness, and cyanosis (blue lips/skin).
High Altitude Cerebral Edema (HACE): Brain swelling, leading to confusion, ataxia (loss of coordination), altered mental state, seizures, or coma.
Risk Factors on Uhuru Peak
Rapid ascent (Kilimanjaro climbs often take 5-9 days, but faster itineraries increase risk).
High elevation (5,895m is well above the 2,500m threshold where AMS risk begins).
Individual susceptibility (varies regardless of fitness level).
Treatment
Prevention (Best Approach):
Acclimatization: Choose a longer itinerary (7-9 days) to allow gradual ascent. Include acclimatization days (e.g., climb high, sleep low).
Medications:
Acetazolamide (Diamox): 125-250 mg twice daily, started 1-2 days before ascent, helps speed acclimatization.
Ibuprofen: 600 mg every 8 hours can reduce headache and inflammation.
Hydration: Drink 3-4 liters of water daily to combat dehydration.
Nutrition: Maintain a high-calorie, carbohydrate-rich diet to fuel energy needs.
Avoid alcohol and sedatives: These depress breathing and worsen symptoms.
Managing Mild AMS:
Stop ascending: Rest at the same altitude until symptoms improve (usually 12-48 hours).
Pain relief: Ibuprofen or paracetamol for headaches.
Anti-nausea medication: Ondansetron for nausea/vomiting.
Oxygen supplementation: Portable oxygen canisters can provide temporary relief.
Severe AMS, HAPE, or HACE:
Immediate descent: Descend at least 500-1,000 meters as soon as possible. This is the most effective treatment.
Oxygen therapy: Administer supplemental oxygen if available.
Medications:
Dexamethasone: 4-8 mg every 6 hours for HACE to reduce brain swelling.
Nifedipine or sildenafil: For HAPE, to reduce pulmonary artery pressure.
Portable hyperbaric chamber (Gamow bag): Mimics lower altitude; used if descent is delayed.
Evacuation: Arrange for rescue if symptoms persist or worsen.
Daily checkups
Monitor symptoms: Use the Lake Louise Score (self-assessment tool) to gauge AMS severity.
Guides and support: Reputable Kilimanjaro operators monitor climbers’ health (e.g., pulse oximetry) and carry emergency equipment.
When to turn back: If moderate/severe symptoms appear below Uhuru Peak (e.g., at Barafu Camp, ~4,600m), descending is safer than pushing to the summit.
Post-summit care: Symptoms may persist after descent; seek medical attention if they don’t resolve within 1-2 days.
Our guides are experienced in treating altitude sickness.
Mild forms of altitude sickness are best treated by rest, maintaining fluid intake, and by a painkiller such as paracetamol. Mild symptoms which have lasted for 24 hours or more can be treated with Diamox which aids acclimatization. Some people take Diamox before the climb as prescribed by their doctor. The use of Diamox in this manner is a personal decision. We as a company think it is better to listen to your body and give it a chance to acclimatize naturally before resorting to the use of Diamox. Serious cases of altitude sickness can only be treated by immediate descent.
The chief guide on the trip has received first aid training from both Kilimanjaro National Park and The African Walking Company. Our guides are all experienced in dealing with the problems of altitude and their decision will be final. If there is a potential problem, the guide will take precautionary action and inform both the national park and our office in Arusha. Contact is usually made by mobile phone, as there is network coverage somewhere on each day while climbing Kilimanjaro. There are a number of national park ranger posts on Kilimanjaro and they also have radios to contact park headquarters in Marangu.
Evacuation from Kilimanjaro is initially either on foot or wheeled stretcher. This is until the highest access point that the national park rescue car can reach – either Shira Plateau, below Mandara Hut or Rongai Gate. The rescue car will transport the sick client off the mountain but often it is necessary for our vehicle to meet the rescue car to complete the journey. During the rescue an assistant guide would accompany the sick client. If the client is very sick the chief guide would accompany the sick client, and leave the group on Kilimanjaro under the charge of his assistant. The client is taken to either a doctor (KCMC Hospital in Moshi, or AAR Clinic in Arusha) or as in many cases the client has recovered due to losing altitude, and rests at a hotel.
During the rescue the sick client is accompanied by one of the guides and looked after carefully. On the morning after the rescue the guide would meet the client again. At this time there is a telephone communication from executive staff to ensure that the correct medical care is being offered and the client’s wishes are being taken care of. This guide is then available to help the client in any way, whether they need to go to the doctor or do a short walk around town.
The trip coordinators of The African Walking Company are also involved in looking after the recovery of sick clients as they are conveniently based in Arusha and Marangu. In serious cases, one of the senior management of the company would visit the client to ensure the treatment and other arrangements are the best possible.
Group medical kits and emergency oxygen canisters are provided on all climbs.  All guides have had first aid training. We do not carry Gamow bags or oxygen on our standard climbs. We pay special attention to avoid altitude sickness by maximizing acclimatization. And the guides training means they can recognize the symptoms of serious altitude sickness and organize and immediate descent, which is by far the best treatment, on the occasions when this is necessary.