Kilimanjaro altitude sickness

Jul 7, 2022
Reading time: 11 minutes

You cannot talk about Kilimanjaro without discussing altitude sickness. This is because the trek requires you to climb to nearly 6,000 m above sea level! The air is very thin at that elevation, and affects everyone, even the fittest of climbers.

Altitude sickness is not uncommon on Mount Kilimanjaro, also known as the Roof of Africa in Tanzania, and the highest peak in Africa, and tallest freestanding peak in the world! Towering at an incredible 5895m above sea level, climbing this majestic mountain has its challenges. The most common of them all? Altitude sickness. Altitude sickness on Kilimanjaro and your overall safety on the mountain go hand in hand, and should be taken very seriously. In this article we cover the effects of enduring high altitudes, what to expect and how to overcome it.

What is altitude sickness?

Altitude sickness, or acute mountain sickness (AMS), is a negative health effect of high altitude. The percentage of oxygen in the atmosphere at sea level is about 21%. As you climb higher up the mountain the percentage remains the same but the number of oxygen molecules per breath is reduced. At 3,600 m (12,000 ft), there are roughly 40% fewer oxygen molecules per breath. The body therefore finds it hard to adapt and function as normal with less oxygen. Altitude sickness is caused by a failure of the body to adapt quickly enough to these lower levels of oxygen. Often climbers make the mistake of going too high (altitude) too quickly (rate of ascent).

But don't worry, it is perfectly normal to get altitude sickness on Kilimanjaro. In fact, at over 3,000 metres more than 75% of climbers will experience at least some form of mild AMS. It is therefore more than likely that you will experience some form of altitude sickness when climbing Kilimanjaro. Age, sex or physical fitness have no effect on your likelihood of getting altitude sickness. Just because you haven't had it before doesn't mean you won't develop it on another trip. It is essential you are clued up.


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Can altitude sickness be avoided?

First and foremost, being well prepared for your climb will always put you one step closer to a successful and stress free climb. It is good to know that there is no way to ensure that you don't get affected by altitude sickness. There is a common misconception that if you are physically fit, you are less likely to endure altitude sickness. While physical fitness and altitude sickness correlate, they are not directly linked to one another. By this we mean that if you are physically fit, your body is more likely to withstand and manage the pressures of consecutive days of hiking, which makes any additional altitude sickness symptoms that may arise slightly more bearable.

So even though there is no routine to avoid it all together, there are a couple of things you can do to prepare. If you are able to, try to climb high mountains as often as possible to give your body an idea of what to expect. There have also been instances of people training with altitude masks. This is basically a mask that emulates the decrease in oxygen that you will experience on your climb, giving you the opportunity to experience it beforehand. Whether or not this is effective in avoiding AMS as a whole is still unclear, but if you have the option why not give it a go?

What are the symptoms of mild altitude sickness?

Most high altitude sickness symptoms are very normal when climbing Kilimanjaro. They are generally mild and appear a few hours after moving to higher altitudes. Altitude sickness symptoms have been likened to experiencing a bad hangover and are generally worse at night when respiratory drive is decreased. Mild forms of altitude sickness may include experiencing:

  • headaches
  • sleep disturbance
  • fatigue
  • shortness of breath with physical exertion
  • dizziness
  • loss of appetite
  • nausea and vomiting
  • irritability
  • muscle aches
  • swelling of the hands, feet, and face
  • a rapid heartbeat

The occurrence of altitude sickness is dependent upon the elevation, the rate of ascent, and individual susceptibility. Everyone acclimatises at different rates. The symptoms usually start 12 to 24 hours after arrival at altitude. They generally begin to decrease in severity around the third day.

More than 75% of climbers will experience at least some form of mild altitude sickness on Kilimanjaro.

A man looking ahead at the peak of Kilimanjaro


How to treat mild symptoms

Mild symptoms of altitude sickness on Kilimanjaro are common and easily treated. The best and most efficient treatment is to descend if need be. You need to rest and maintain fluid intake. Painkillers such as paracetamol also help. At Follow Alice we believe it is better to listen to your body. We recommend giving your body a chance to acclimatise naturally before resorting to the use of medicine. However, the NHS recommends travelling with these medicines:

  • acetazolamide to prevent and treat high altitude sickness
  • ibuprofen and paracetamol for headaches
  • anti-sickness medication, like promethazine, for nausea

There are also natural remedies you can try for treating mild symptoms of altitude sickness on Kilimanjaro. These include ginger, lavender oil, garlic and cloves. Please remember that mild altitude symptoms are to be expected. They do not interfere with normal activity and symptoms generally subside as the body acclimatises. As soon as you acclimatise, you will feel better with no lasting side effects. This means you can carry on with your climb.

Please remember that mild altitude symptoms are to be expected.

Kilimanjaro altitude sickness


What are severe symptoms?

It is very rare that a climber will experience anything more than the common mild altitude sickness symptoms listed above. However, it is important for your Kilimanjaro safety that you are aware of all possibilities. If left untreated, severe symptoms of altitude sickness can be fatal. This is why it is so important to communicate your symptoms if you are feeling unwell. If you experience a severe case of altitude sickness you may experience symptoms such as:

  • wet coughing
  • chest congestion
  • extreme fatigue
  • fast, shallow breathing
  • gurgling breaths
  • blue or grey lips or fingernails
  • pale complexion and skin discolouration
  • inability to walk or lack of balance (ataxia)
  • confusion
  • social withdrawal

It's important for your safety that you be aware of all possibilities.

Descending in an emergency

Severe cases of altitude sickness on Kilimanjaro can only be treated by immediate descent of around 2,000 feet (600 m) to a lower altitude. If a climber really feels unwell and has to descend, our guides will take him or her down immediately. This is normally by assisting, or in severe cases with a portable stretcher. At Follow Alice we have a minimum of 1 guide per 2 climbers ratio, which means in a group of 8 climbers, there are at least 4 guides. So in an emergency case, there are always enough guides to make sure everyone is still 100% safe and taken care of.

They should also be followed up by a visit to the doctor for any necessary treatment. As mentioned, it is very rare that climbers experience these more serious side effects. Your guide will ensure you are acclimatising well. This is achieved by enforcing multiple acclimatisation procedures.

Ariel view of Mount Kilimanjaro


What are HAPE and HACE?

If severe symptoms of altitude sickness are ignored, they can lead to life-threatening conditions affecting the brain or lungs. This is considered severe altitude sickness. There are two serious conditions associated with severe altitude sickness:

  • High altitude pulmonary edema (HAPE), which is a build-up of fluid in the lungs
  • High altitude cerebral edema (HACE), which is the swelling of the brain caused by a lack of oxygen

These conditions are very rare. But when they do occur, it's usually because you went too high too quickly and stayed at that height. In both HAPE and HACE, the lack of oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain.

HAPE symptoms and treatment

The symptoms of HAPE include a blue tinge to the skin (cyanosis), breathing difficulties (even when resting), tightness in the chest, a persistent cough, bringing up pink or white frothy liquid (sputum), tiredness and weakness.

HAPE treatment includes moving down to a lower altitude immediately, taking nifedipine (helps to reduce chest tightness and ease breathing), and using bottled oxygen.

HACE symptoms and treatment

HACE symptoms include headache, weakness, nausea and vomiting, loss of coordination, feeling confused, and hallucinations.

HACE treatment includes moving down to a lower altitude immediately, taking dexamethasone (a steroid medication that reduces swelling of the brain), and using bottled oxygen.

Chris on mountain with oxygen cylinder

Follow Alice lead guide Chris holding an oxygen canister on Kilimanjaro

What is the best acclimatisation process?

Given enough time, your body will adapt to the decrease in oxygen at a specific altitude. This process is known as acclimatisation. It generally takes one to three days at any given altitude. This is why having the right itinerary for the right Kilimanjaro route is so essential. Most Kilimanjaro routes offer a good acclimatisation profile. However, don't underestimate the effects of the high altitude. At Follow Alice we have the following acclimatisation procedures in place to make sure you reach the summit safely:

1. Climb high, sleep low

This basically means climbing to a higher altitude during the day and sleeping at a lower altitude at night. This acclimatisation procedure is achieved through well-planned itineraries. These include afternoon acclimatisation hikes to a higher level (climbing high) before descending to camp (sleeping low). Follow Alice itineraries are designed around this key acclimatisation procedure. We regularly recommend the Lemosho route because it, along with the Northern Circuit and Machame route, provides the best climb high, sleep low opportunity. You can see this demonstrated in the route height map below.

7 days Kilimanjaro Lemosho route heightmap


2. Drink lots of water

You dehydrate faster when your breathing becomes heavy and quick. We therefore recommend a daily fluid intake of 4-5 litres. Fluid intake improves circulation and most other bodily functions. Our menu on the mountain accordingly contains lots of soup, hot drinks and fresh fruit. Check your urine to make sure you are drinking enough. Avoid consuming alcohol on your climb.

A lady drinking water on Mount Kilimanjaro to help ease altitude sickness


3. Climb slowly

One of the important points to note about climbing Kilimanjaro is that it is not a race. On the climb you will hear your guides use the phrase "pole, pole". This means "slowly, slowly" in Swahili. On your way to the top, expect to hike about 4-7h per day and around 10-14h on summit day. On summit day, the oxygen levels are low. Expect to be taking one step at a time - quite literally!

Pole, pole means 'slowly, slowly' in Swahili. Your trek guides say this to you all the time on Kilimanjaro to remind you to just take things slowly and steadily. Kilimanjaro isn't a race!

Staying safe on the mountain

There is a lot to consider when preparing for your Kilimanjaro climb and by paying careful consideration to the below factors, challenges such as altitude sickness on Kilimanjaro can be managed as safely and stress free as possible:

Choose a qualified tour operator

There are many ways to prioritise your safety on Kilimanjaro. Above all, you need to be sure to choose the right Kilimanjaro tour operator. This decision can make or break a safe and enjoyable climb. At Follow Alice we therefore prioritise your Kilimanjaro safety above everything else. We aim to treat the initial causes of any sickness rather than waiting for the symptoms to appear. Prevention is key. Having the right knowledge gives you the tools to keep yourself as safe as possible. We like to think of ourselves as value for money operators. At Follow Alice we focus on keeping the Kilimanjaro climb costs to a minimum without compromising on safety, quality equipment and nutrition. Take your time in carefully choosing your tour operator. Also find out when is the best time to climb Kilimanjaro.

Experienced guides

Having an experienced guide should be at the very top of your list of important considerations for climbing Kilimanjaro. Ensure that your Kilimanjaro guide is highly experienced in preventing, detecting, and treating altitude sickness. Follow Alice Kilimanjaro guides are certified Wilderness First Responders (WFR). They have the tools to make critical medical and evacuation decisions on site.

Kilimanjaro summit Roger, James, Robert and Andrew

It takes well-trained guides to see clients safely to the summit

We felt greatly taken care of by the Follow Alice crew! The guides made us feel safe at all times.


The right equipment

On the mountain, you and your mountain crew will have access to the necessary equipment to assist in keeping you safe. This includes a medical kit, emergency oxygen, a stretcher and a pulse oximeter. A pulse oximeter measures the oxygen in your blood, revealing whether or not you are acclimatising well. You will get routine checkups throughout your climb.

Oxygen saturation at altitude



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