Mount Kilimanjaro Medical List and Altitude Sickness

INFORMATION
  • Information supplied by Dr. K. Rivett, Dr. H. Bloch, Travel Clinics and various other successful climbers.
  • Diamox 250mg
  • For altitude sickness. Max 3/day from day 1 (Or before). Good supply – or Azomid (Generic).
  • Headache/Pain Pills
  • Not too strong, otherwise it may mask more serious symptoms
  • Basic Antiseptic Cream
  • For cuts / blisters and plasters (Elastoplast) and small scissors for blisters
  • Imodium & Buscopan
  • Stomach disorders – good supply
  • Motilium
  • For nausea – good supply
  • Sun protective
  • Lip-ice, Zinc balm, Sun-screen factor 20 or more for protection from the sun, wind and ice-glare
  • Rehydration Salts
  • In case of dehydration
  • Support bandage / Anti-inflammatory tablets and creams
  • For aching joints esp. on decent
  • Decadron (Steriod) & Sleeping pills
  • These both help, but you must check with a doctor before using.
  • Water purification Tablets
  • Enough for approx. 21-25 litres of water
  • Extra
  • Vitamist – Natural spray product
  • Calmeg – To avoid cramping
  • Vitamin E – Assist in oxygenation process
  • Extend – For muscle strength and stamina
  • B12 – For energy

 

ALTITUDE SICKNESS ETC – INFORMATION FOR CLIMBERS

Notes on use of Oxygen
Whilst one may feel the need for oxygen on Kili to help you breathe better, its use is not recommended by top guides. Its use on a mountain such as this, with easy, quick descent routes, is not required. Use of oxygen to extend time at altitude by unqualified people may mask greater symptoms of Altitude sickness, and may cause even greater trauma and death. Limited amounts of oxygen such as are sometimes carried for “emergencies “are of little or no use, and as mentioned may cause unnecessary additional injury.

“Delaying descent for any reason is dangerous “– Going High by Charles S Houston MD. Because visitors ascend Kilimanjaro at a much slower rate, and start walking from a much lower altitude the serious problems associated with high altitude acclimatization are less frequently encountered.

Specifically, the number of cases of Pulmonary and Cerebral Oedema (HAPE & HACE), as a percentage of climbers ascending the mountain, are considerably less. In part this is due to a longer acclimatization period, but also to the fact that if a walker is feeling ill at the 4000m point, he may be unwilling to push on for a further 2 days, getting worse the whole time. Thus he goes on down. Because of the higher altitude of Kilimanjaro, Acute Mountain Sickness, (AMS) is more common.

The incidence of appetite loss, headache, nausea and vomiting are higher, affecting to a greater or lesser extent, 80% or more of the visitors to the Kibo Hut / Barafu area (4600m) and above. It should be noted that the majority have very mild symptoms, which can be treated on site.

Information and recommendation contained in the section below should be regarded as a guide only. More detailed medical information can be obtained from such specialist publications as “Medicine for Mountaineering” published by The Mountaineers of Seattle, USA; or, Mountain Medicine and Physiology” published by the Alpine Club in London.

Specific high altitude problems
Caused through the inability of the human body to adjust to a rapid gain in altitude, problems range from mild cases of AMS, experienced to some extent by most climbers, through its various forms to the often fatal Pulmonary and Cerebral Oedema’s, the latter being less common.

Oddly enough, young fit males seem to be the worst affected by altitude.

Symptoms of AMS include, (in the order usually experienced), headache, nausea, vomiting, anorexia, exhaustion, lassitude, muscle weakness, a rapid pulse even at rest (±120/min), insomnia, swelling of the hands and feet and a reduced urine output. Climbers with severe symptoms MUST stop ascending and seriously consider descending to a lower altitude. Use of the drug Diamox can help prevent or reduce the severity of AMS.

With Pulmonary Oedema, additional symptoms may be noticed – shortness of breath, even at rest, gurgling bubbly sounds in the chest and sometimes a watery blood-tinged sputum. The skin may be cold and clammy and the finger nails and lips bluish. With Cerebral Oedema, severe headache, hallucination and lack of co-ordination are additional symptoms. Treatment must be immediate. DESCEND! Even if it means walking down at night. The speed with which these two conditions kill is often as little as 12 hours from when the symptoms first become apparent. If bottled oxygen is available, it should be used.

Precautions that the visitor can take to help minimize the severity of mountain sickness include:

1. Staying a night at 3000m and an extra night at 3800m (Horombo / Shira / Barranco).

2. Maintain a slow steady pace whilst walking up. (There is little point in trying to outdistance everyone else, for even at a slow pace, the time between huts is seldom in excess of 6 hours on the Marangu Route and 7 hours on the camping routes).

3. Drink at least 4-6 litres of fluids each day. Dehydration, even mild, leads to a thickening of the blood with increased possibility of pulmonary embolism or a thrombosis. Urine colour should be pale and the output copious. The mantra “Copious and clear“ should be remembered.

Exposure: Or more correctly, hypothermia is the lowering of the body’s core temperature.
Prevention is the best course of action. Use appropriate equipment. Do not allow yourself or your clothing to become wet – either from rain or perspiration.

When at rest, keep out of the wind. Treatment is simple and needs to be carried out as quickly as possible. If a hut or natural shelter is not close by, a tent, bivi bag or similar protection should be arranged to keep the victim dry.

REMOVE wet clothing and place the victim in a sleeping bag (or two or three), if possible, another person should be placed in the bag as well. Direct skin-to-skin contact is best. Once the victim is conscious, hot drinks will go a long way to boost morale.

Frostbite, though unlikely to kill, can result in later loss, through amputation, of the body’s extremities such as fingers and toes.

Equipment in the form of good mittens, good footwear and keeping dry is 90% of the way towards preventing the problem.

Warning signs are severe pains in the affected area followed by a complete loss of feeling there. Colour of the affected area will be almost white.

Sun related injuries
As about 50% of the earth’s protective atmosphere is below an altitude of 5000m, far less of the harmful low frequency ultra violet light is filtered out, and the suns rays are much more powerful.

This can result in very rapid burning of exposed skin.

A preparation of 5% PABA in zinc oxide cream, or a factor 35+ sun cream is recommended protection.

Dark glasses with side panels, ‘wraparounds’, or proper snow goggles, are best worn at all times above 4 000m, especially when the sun is out, and are essential when crossing snow or ice, even in cloudy conditions. Snow blindness is a very painful experience.

Eye drops may help though the only real cure is to keep the eyes bandaged up for 24 hrs or more.

Feet problems
Blisters are usually a result of poor fitting, new or little used boots. As soon as a ‘hot spot’ is felt, stop, remove the boot and cover the area in a zinc oxide tape, moleskin or gel tape.

If boots are even slightly too small, the toes will hit against the front of the boots and be badly bruised, particularly when descending.

Toenails should be kept as short as possible.

Cuts and abrasions
Stop bleeding with direct pressure to the wound. If an artery has been cut, a tourniquet should, if direct pressure is ineffective, be applied above the cut. Note that the tourniquet should not be so tight as to cut off circulation to the part.

Clean wounds and the surrounding area with water and soap, preferably antibacterial. Usually it is best not to cover abrasions and small cuts, but rather let them dry out.

Trauma
Usually results from a broken limb or other major injury.

Medication should not be given unless pain is extreme, for the victim’s ability to co-operate or make decisions is reduced. Furthermore there is the risk that it may contribute to depressing the vital functions.

In all instances, if drugs are given, record the brand name, amount and the time that it was administered.

Fitness
Any walker who suffers from a pulmonary or cardiac problem should be particularly cautious about going on the mountain. If there is any doubt, consult a doctor.

Normal preparation for a mountain ascent should include several long walks before hand, with, if possible, some steep uphill sections. If possible use the same footwear one intends to use on the mountain and carry a light pack as well.

Above taken from: Kilimanjaro 1;50000 Map and Guide . By Mark Savage 1997

A word on Kilimanjaro toilets:

They are not in good condition, and are badly maintained by the Parks. USE THEM. If you have to go between toilet stops, make sure you do not leave signs of your passing behind!!!!! Take a small plastic bag for dirty toilet paper, and discard it properly at the next camp.

The below is from an Everest hiker, found on the door of a long drop “somewhere in the Himalayas”

I long for a long drop wild and free with which to greet the dawning.

I yearn for a long drop that’s not full, in which to meet the morning.

I dream of a loo that’s lemon scented: To hope that it’s clean, I’m unrepentant.

An Adventurous Spirit, I would not spoil it, But, gee, ‘”would be nice with a sit down toilet”

Remember to pack a large pack of sense of humour

Mountain Sickness Rating
The below chart of fairly common symptoms will allow you an idea of how badly the mountain sickness if affecting you and the suggested treatment. This is a personal guide…your mountain guide and your own feelings will determine the rest. Take note of the symptoms of HAPE (High Altitude Pulmonary Edema) HACE (High Altitude Cerebral Edema).
Symptom and Score
  • Headache – 1
  • Nausea & appetite loss – 1
  • Insomnia – 1
  • Giddiness / Dizziness – 1
  • Headache that remain after Aspirin – 2
  • Vomiting – 2
  • Difficulty breathing at rest – 3
  • Abnormal or intense fatigue – 3
  • Decreased urination – 3
  • Symptoms may disappear / lessen as day progresses e.g. you may feel ill after lunch, but fine after a rest and cup of tea on arriving in camp mid afternoon etc. Symptoms that last for extended periods are what you must take notice of. In the final analysis YOU know how YOU are feeling.
  • Add up your “score” and then determine your condition and treatment below:
  • 1 – 3
  • Light Mountain Sickness
  • Asprin
  • 4 – 6
  • Mid Mountain Sickness
  • Asprin + Rest + Stop Ascending
  • 6 +
  • Acute Mountain Sickness
  • DESCENT – Immediately – No messing – get DOWN!
  • Source: Himalayan Kingdom Expeditions Trip Dossier 1998