Your Safety on Mount Kilimanjaro

Dear Adventurer,
Embarking on a journey to summit Mount Kilimanjaro is a commendable endeavor that requires meticulous preparation, particularly concerning the prevention of altitude-related illnesses such as Acute Mountain Sickness (AMS), High-Altitude Cerebral Edema (HACE), and High-Altitude Pulmonary Edema (HAPE). These conditions arise due to reduced oxygen levels at high elevations and can significantly impact your health and the success of your expedition. Below is an evidence-based guide to help you mitigate the risks associated with high-altitude trekking.
📖 If you would like to read the scientific article describing the evidence for prevention of altitude-related illnesses, this is a good start: Luks AM et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update. Wilderness Environ Med. 2024 Mar;35(1_suppl):2S–19S.
DOI: 10.1016/j.wem.2023.05.013
PMID: 37833187

1️⃣ Gradual Ascent and Acclimatization

The cornerstone of preventing altitude sickness is a gradual ascent, allowing your body adequate time to acclimate to decreasing oxygen levels. It is advisable to limit your daily elevation gain to no more than 500 meters above 3,000 meters and incorporate a rest day every three to four days. This approach aligns with the Wilderness Medical Society's guidelines for altitude illness prevention.

2️⃣ Pharmacological Prophylaxis

Certain medications have demonstrated efficacy in preventing altitude-related illnesses:
Acetazolamide (Diamox):
This medication facilitates acclimatization by promoting a slight metabolic acidosis, which stimulates ventilation.
Prophylactic dosage: 125 mg twice daily, starting 24 hours before ascent and continuing for a few days at the highest altitude or upon descent.
Dexamethasone:
A corticosteroid effective in preventing AMS and HACE. It is generally reserved for individuals who cannot tolerate acetazolamide.
Prophylactic dosage: 2 mg every six hours or 4 mg every 12 hours.
Nifedipine:
A calcium channel blocker shown to prevent HAPE by reducing pulmonary artery pressure.
Particularly recommended for individuals with a history of HAPE.

3️⃣ Pre-Acclimatization Strategies

Pre-acclimatization involves exposing your body to hypoxic conditions before the actual ascent, thereby enhancing tolerance to high altitudes. Methods such as using altitude simulation tents or engaging in intermittent hypoxic training can be beneficial.

4️⃣ Hydration and Nutrition

Maintaining proper hydration is essential, as high altitudes can lead to increased fluid loss through respiration. However, avoid overhydration, which can result in hyponatremia. A balanced diet rich in carbohydrates provides necessary energy and aids in acclimatization.

5️⃣ Avoiding Respiratory Depressants

Substances such as alcohol and sedatives can depress respiration and exacerbate altitude sickness symptoms. It is prudent to avoid these, particularly during the initial days at high altitude.

6️⃣ Monitoring and Early Recognition

Familiarize yourself with the early symptoms of altitude illnesses, including:
* Headaches
* Nausea
* Dizziness
* Fatigue
Early recognition and prompt response, such as halting ascent or descending to a lower altitude, are crucial in preventing progression to more severe conditions like HACE and HAPE.

7️⃣ Emergency Preparedness

Equip yourself with a well-stocked medical kit that includes medications like acetazolamide and dexamethasone. Portable oxygen and a clear evacuation plan are also vital components of emergency preparedness.
✅ Ask your guides if they will carry an oxygen tank to the summit.

🏔️ Final Words

By adhering to these guidelines and listening to your body, you can significantly reduce the risk of altitude sickness and enhance your experience on Mount Kilimanjaro.
Wishing you a safe and rewarding ascent.
Damjan Osredkar, MD, PhD
🌐 osre.dk/ar