Acute mountain sickness management: Case of Mount Kilimanjaro and review of literature

Abstract

Background: High-altitude Illness is the collective term for all illnesses occurring at or during terrestrial elevations over 1500m, it encompasses acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and High-altitude Pulmonary Oedema (HAPE).High- altitude-related problems consist of the common syndrome of acute mountain sickness, which is relatively benign and usually self-limiting, and the rarer, more serious syndromes of high-altitude cerebral oedema and high-altitude pulmonary oedema. A common feature of acute altitude illness is rapid ascent by otherwise fit individuals to altitudes above 3000 m without sufficient time to acclimatize which is accompanies with many hypobaric hypoxia related complications which if not managed on time results into death, especially when ascending mountain with sharp ascent like Kilimanjaro Acute Mountain Sickness is the first manifestation of High-altitude illness, it can be easily prevented and managed but most of the time AMS symptoms are ignored or mismanaged hence resulting into death. The susceptibility of an individual to high-altitude syndromes is variable but generally reproducible. Prevention of altitude-related illness by slow ascent is the best approach, but this is not always practical, especially in Mountains like Kilimanjaro with very low medical resources. The immediate management of AMS requires oxygen and descent of more than 300 m as soon as possible, accompanied other pharmacological and non-pharmacological management from well-trained health care providers, tour guides, porters and mountain guards.
Methods: A Systematic review of case studies, research articles and guidelines for prevention and treatment of Acute Mountain Sickness (AMS) in Mt. Kilimanjaro. Searches from PubMed, MEDLINE and EMBASE from inception to October 2018, a total of 247 peer reviewed articles and case studies, 2 international guidelines, 17 books and 1 conference proceeding were used to prepare this article.
Results: Detailed review of Acute Mountain Sickness management and other High-altitude clinical complications in Kilimanjaro (HACE and HAPE). This review provides detailed information about each of these important clinical entities. After reviewing the clinical features, epidemiology and current understanding of the pathophysiology of each disorder, the article describe the current pharmacological and non-pharmacological approaches to the prevention and treatment of these diseases. A total of 247 articles and case studies, 2 international guidelines, 17 books and 1 conference proceeding were used for this review. All articles searches where from peer reviewed sources, majority were international though thorough searches and emphasis was for those written about AMS in Mt. Kilimanjaro. Majority authors were from were from the global north (Europeans and Americans)
Conclusion: Currently there is an increase in number of cases of high-altitude illnesses and deaths reported in Mt. Kilimanjaro. Many of these travellers seek medical advice prior to expedition from inexperienced practitioners around world or under resourced and inexperienced health care providers in Tanzania. In this Review article, I describe the setting and clinical features of acute mountain sickness, an overview of the known pathophysiology, prevention, treatment and comprehensive evidence based recommendations for health care providers in Africa.