Altitude Acclimatisation

Altitude acclimatization is the process of adjusting to decreasing oxygen levels at higher
elevations, in order to avoid altitude sickness. Once above approximately 3,000 metres
(10,000 feet = 70 kPa), most climbers and high-altitude trekkers take the "climb-high, sleep-low"
approach.
Mount Kilimanjaro raised 5895 metres above the sea level. Due to its high height, climbing it is
probably one of the most dangerous things you will ever do. Approximately 500 climbers have
been reported to be evacuated from the mountain and maximum of 6 deaths have also reported
each year. The main cause of death is altitude sickness. Tro-peaks adventure recommends to
everyone climbing Mount Kilimanjaro should be familiar with the signs and symptoms of
altitude sickness.
ACUTE MOUNTAIN SICKNESS.
Acute mountain sickness is an illness that can affect mountain climbers, hikers or any travelers at
high altitudes, usually above 10,000 feet (3,000 meters).
The percentage of oxygen in the atmosphere at sea level is about 21%. As altitude increases, the
percentage remains the same but the number of oxygen molecules per breath is reduced.
From 10,000 feet (3,000 metres) and above there are fewer oxygen molecules per breath so the
body must adjust having less oxygen.
AMS is caused by reduced air pressure and lower oxygen levels at high altitudes. The faster you
climb to a high altitude, the more likely you will get AMS.
According to the experience, it is difficult to determine who may be affected by altitude sickness
since there are no specific factors such as age, sex, or physical condition that correlate with
susceptibility.
Normally climbers will start experience the form of mild AMS from the elevation of 10,000feet
(3000m) and above.
Some of the factors related to AMS are:
 High Altitude
 Fast Rate of Ascent
 High Degree of Extertion
 Dehydration
AMS is very common at high altitude and many people will experience mild AMS during the
acclimatization process. The symptoms usually start 12 to 24 hours after arrival at altitude and
will normally disappear within 48 hours. The sign and symptoms of Mild AMS are:

 Difficulty sleeping
 Dizziness or light-headedness
 Fatigue
 Headache
 Loss of appetite
 Nausea or vomiting
 Rapid Pulse (heart rate)
 Shortness of breath with exertion
Symptoms that may occur with more severe acute mountain sickness include:
 Blue color to the skin (cyanosis)
 Chest tightness or congestion
 Confusion.
 Cough
 Coughing up blood
 Decreased consciousness or withdrawal from social interaction
 Gray or pale complexion
 Cannot walk in a straight line, or walk at all
 Shortness of breath at rest
 Fluid build-up in the lungs
NOTE NO.1: Symptoms tend to be worse at night and when respiratory drive is decreased.
Mild AMS does not interfere with normal activity and symptoms generally subside as the body
acclimatizes. As long as symptoms are mild, and only a nuisance, ascent can continue at a
moderate rate.
NOTE NO. 2: When climbing it is important to be open to the guides or other climber in your
trip with any sign or symptom of illness immediately because to continue to the high altitude
while affect with moderate AMS without be treated or helped can lead to DEATH.
NOTE NO. 3: Normal activity is difficult, although the person may still be able to walk on their
own. At this stage, only advanced medications or descent can reverse the problem. It is important
to get the person to descend before the ataxia reaches the point where they cannot walk on their
own (which would necessitate a stretcher evacuation). Descending only 1,000 feet (300 m) will
result in some improvement, and 24 hours at the lower altitude will result in a significant
improvement. The person should remain at lower altitude until all the symptoms have subsided.
At this point, the person has become acclimatized to that altitude and can begin ascending again.
NOTE NO. 4: Severe AMS requires immediate descent of around 2,000 feet (600 m) to a lower
altitude. AMS can progress to (HAPE) High Altitude Pulmonary Edema or (HACE) High
Altitude Cerebral Edema which are potential fatal. Both of these happen less frequently,
especially to those who are properly acclimatized. But, when they do occur, it is usually in
people going too high too fast or going very high and staying there. In both cases the lack of
oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain.

High Altitude Pulmonary Edema (HAPE) (Fluid in the lungs)
HAPE is a result from fluid accumulation in the lungs. This fluid prevents effective oxygen
exchange. As the condition becomes more severe, the level of oxygen in the blood stream
decreases, which leads to cyanosis, impaired cerebral function and death on the mountain.
Symptoms and Sign of HAPE are:

 Difficulty in breathing at rest
 Cough which bringing up white, watery, or frothy fluid
 Weakness or decreased exercise performance
 Chest tightness or congestion
 Crackles or wheezing (while breathing) in at least one lung field
 Skin, Finger nail and Eye color change into blue.
 Rapid shallow breathing
 Rapid heart rate
 Confusion and irrational behavior.

NOTE: Confusion and irrational behavior are signs that insufficient oxygen is reaching the
brain. In cases of HAPE, immediate descent of around 2,000 feet (600 m) is a necessary life-
saving measure. Anyone suffering from HAPE must be evacuated to a medical facility for proper
follow-up treatment.
High Altitude Cerebral Edema (HACE) (Swelling of Brain)
HACE is a condition in which the brain swells with fluid because of the physiological effects of
traveling to a high altitude. It generally appears in patients who have acute mountain sickness. It
occurs when the body fails to acclimatize.
The symptoms of HACE are:
 Headache
 Weakness
 Disorientation
 Loss of co-ordination
 Decreasing levels of consciousness
 Loss of memory
 Hallucinations & Psychotic behavior
 Coma
NOTE: This condition is rapidly fatal unless the afflicted person experiences immediate descent.
Anyone suffering from HACE must be evacuated to a medical facility for follow-up treatment.

General Prevention of Altitude Sickness.
Keys to preventing altitude sickness include:

 Climb the mountain gradually
 Stop for a day or two of rest for every 2,000 feet (600 meters) above 8,000 feet (2,400
meters)
 Sleep at a lower altitude when possible
 Learn how to recognize early symptoms of mountain sickness
 Drink plenty of fluids
 Avoid alcohol and cigarettes/tobacco.
 Eat regular meals, high in carbohydrates even if you do not have appetite.
If you are traveling above 9,840 feet (3,000 meters), you should carry enough oxygen for several
days Tro-peaks Adventures provides oxygen tanks during the climbs.
If you plan on quickly climbing to a high altitude, ask your doctor about a medication called
acetazolamide (Diamox). This drug helps your body get used to higher altitudes more quickly,
and reduces minor symptoms. It should be taken the day before you climb, and then for the next
1 to 2 days.
If you are at risk for a low red blood cell count (anemia), ask your doctor if an iron supplement is
right for you. Anemia lowers the amount of oxygen in your blood. This makes you more likely to
have mountain sickness.

Proper Acclimatization Guidelines
For achieving of the acclimatization below are recommendations of what you should do:
 Ascend Slowly. Your guides will set a good and slow pace for you as well as telling and
remind you, "Pole, pole" (slowly, slowly) throughout your climb. Doing slowly it takes
time but help acclimatization. Taking rest days will help you increases your chances of
reaching to the top as well as enjoying the environments around.
 Do not overexert yourself. Mild exercise may help altitude acclimatization, but strenuous
activity may promote HAPE.
 Take slow deliberate deep breaths.
 Climb high, sleep low. Climb to a higher altitude during the day, then sleep at a lower
altitude at night. Most routes comply with this principle and additional acclimatization
hikes can be incorporated into your itinerary.
 Eat enough food and drink enough water while on your climb. It is recommended that
you drink from four to five liters of fluid per day. Also, eat a high calorie diet while at
altitude, even if your appetite is diminished.
 Avoid tobacco, alcohol and other depressant drugs including, barbiturates, tranquillizers,
sleeping pills and opiates. These further decrease the respiratory drive during sleep
resulting in a worsening of altitude sickness.
 If you begin to show symptoms of moderate altitude sickness, don't go higher until
symptoms decrease. If symptoms increase, descend.
 Our GUIDES are well trained with full skilled and knowledge of First Aid and
Leadership so they all have enough ability in recognizing and identifying the high
altitude sickness and quickly take a right measures on saving the client life without

delaying. They will constantly monitor your well-being on the climb by watching you
and speaking with you every time. Tro-Peaks Adventure company have a system planted
to all of our guides whereby our guides will conduct tests twice a day with a pulse
oximeter to measure your oxygen saturation and pulse rate as a way to know if you are
doing good and if not what measure can be taken to help you. Additionally, our guides
will administer the knowledge they have which will help on determine whether you have
any symptoms of altitude sickness and the severity.
It is important for you to be open, honest and transparent with the way your body feels to your
Guide. If you do not feel well, do not try to pretend that you are fine because it will end up create
a very bad situation even death. But providing the truth information to the guide with the
negative way your body feels it will help him to provide you with a good ideal or treatments
which will help you to proceed with your climb do not think while you report your problem to
the guide he will descend you down from the mountain as some people think.
Of course, there is always the chance that you will have to abandon your climb. In these
situations, the guide will tell you to descend. It is not a request, but an order. The guide's
decision is final. Do not try to convince him with words, threats or money to continue your
climb. The guide wants you to succeed on your climb, but will not jeopardize your health.
Respect the decision of the guide.
Pulse Oximeter
Pulse Oximeter is a device machine which are used to measure-spot-check your blood oxygen
saturation (SpO2) and pulse rate during the climbing.
The oximeters that we use on Mt. Kilimanjaro, Kenya, Rwenzory and Meru is placed on a
climber’s fingertip and automatically start reading and provide the result of oxygen and pulse
rates which then will determine your health condition.
Oxygen saturation is a measurement of how much oxygen your blood is carrying as a percentage
of the maximum it could carry. Normal blood oxygen levels at sea level are 95-100%.
Our Guides do normally monitor clients’ oxygen amount and pulse rates twice a day by the use
of this device as our rules number one for safety.

Diamox
Diamox (generic name acetazolamide) is an F.D.A. approved drug for the prevention and
treatment of AMS. The medication acidifies the blood, which causes an increase in respiration,
thus accelerating acclimatization. Diamox does not disguise symptoms of altitude sickness, it
prevents it. Studies have shown that Diamox at a dose of 250 mg every eight to twelve hours
before and during rapid ascent to altitude results in fewer and/or less severe symptoms of acute
mountain sickness (AMS). The medicine should be continued until you are below the altitude
where symptoms became bothersome. Side effects of acetazolamide include tingling or
numbness in the fingers, toes and face, taste alterations, excessive urination; and rarely, blurring

of vision. These go away when the medicine is stopped. It is a personal choice of the climber
whether or not to take Diamox as a preventative measure against AMS.
Tro-peaks adventures neither advocates nor discourage the use of Diamox. According to our
experience, Diamox is very useful on treating the high altitude sickness on the mountain.
Ibuprofen
Prior to the onset of altitude sickness, ibuprofen is a suggested non-steroidal anti-inflammatory
and painkiller that can help alleviate both the headache and nausea associated with AMS. It has
not been studied for the prevention of Cerebral Edema (swelling of the brain) associated with
extreme symptoms of AMS.

Bottled Oxygen
We carry bottled oxygen on all of our climbs as a precaution and additional safety measure. The
oxygen cannister is for use only in emergency situations. It is NOT used to assist clients who
have not adequately acclimatized on their own to climb higher. The most immediate treatment
for moderate and serious altitude sickness is descent. With Kilimanjaro's routes, it is always
possible to descend, and descend quickly. Therefore, oxygen is used strictly to treat a stricken
climber, when necessary, in conjunction with descent, to treat those with moderate and severe
altitude sickness.
We are aware that some operators market the use of supplementary personal oxygen systems as a
means to eliminate the symptoms of AMS. To administer oxygen in this manner and for this
purpose is dangerous because it is a temporary treatment of altitude sickness. Upon the cessation
of the use of oxygen, the client will be at an even higher altitude without proper acclimatization.
99% of the companies on Kilimanjaro do NOT offer supplementary oxygen – because it is
potentially dangerous, wholly unnecessary and against the spirit of climbing Kilimanjaro. The
challenge of the mountain lies within the fact that the summit is at a high elevation, where
climbers must adapt to lower oxygen levels at altitude. Using supplementary oxygen is akin to
putting the mountain at sea level, where nearly everyone can summit.