Effects of rapid saline infusion on orthostatic intolerance and autonomic tone after 20 days bed rest

Takenaka, Katsu; Suzuki, Yoshio; Uno, Kansei; Sato, Michiko; Komuro, Takako; Haruna, Y; Kobayashi, Hideyuki; Kawakubo, Kiyoshi; Sonoda, Makoto; Asakawa, Masako; Nakahara, Kazuhiko; Gunji, Atsuko

doi:10.1016/s0002-9149(01)02296-2

Cited by 14 publications

(10 citation statements)

References 11 publications

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“…Prolonged periods of complete bed rest should be avoided except in the most severely affected patients. Studies in adults have shown that 2 weeks of complete bed rest can be followed by a substantial reduction in plasma volume, and by OI (102). Striking the right balance between rest and activity while avoiding post-exertional symptoms requires trial and error.…”

Section: Management/treatmentmentioning

confidence: 99%

“…Those with ME/CFS often have low blood volume (57–59), which has been associated with lower renin:aldosterone ratios (58) and with lower ADH levels (165). Physical inactivity results in reductions in plasma volume, thereby aggravating symptoms of OI and interfering further with daily function (102, 166, 167). In patients with increased pooling of blood in the peripheral circulation or low blood volume (or both), the assumption of upright posture is associated with less return of blood to the heart, and a markedly increased catecholamine response (168, 169).…”

Section: Fukuda Research Case Definition For Chronic Fatigue Synmentioning

confidence: 99%

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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer

Underhill²,

et al. 2017

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Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disease that affects children and adolescents as well as adults. The etiology has not been established. While many pediatricians and other health-care providers are aware of ME/CFS, they often lack essential knowledge that is necessary for diagnosis and treatment. Many young patients experience symptoms for years before receiving a diagnosis. This primer, written by the International Writing Group for Pediatric ME/CFS, provides information necessary to understand, diagnose, and manage the symptoms of ME/CFS in children and adolescents. ME/CFS is characterized by overwhelming fatigue with a substantial loss of physical and mental stamina. Cardinal features are malaise and a worsening of symptoms following minimal physical or mental exertion. These post-exertional symptoms can persist for hours, days, or weeks and are not relieved by rest or sleep. Other symptoms include cognitive problems, unrefreshing or disturbed sleep, generalized or localized pain, lightheadedness, and additional symptoms in multiple organ systems. While some young patients can attend school, on a full or part-time basis, many others are wheelchair dependent, housebound, or bedbound. Prevalence estimates for pediatric ME/CFS vary from 0.1 to 0.5%. Because there is no diagnostic test for ME/CFS, diagnosis is purely clinical, based on the history and the exclusion of other fatiguing illnesses by physical examination and medical testing. Co-existing medical conditions including orthostatic intolerance (OI) are common. Successful management is based on determining the optimum balance of rest and activity to help prevent post-exertional symptom worsening. Medications are helpful to treat pain, insomnia, OI and other symptoms. The published literature on ME/CFS and specifically that describing the diagnosis and management of pediatric ME/CFS is very limited. Where published studies are lacking, recommendations are based on the clinical observations and practices of the authors.

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Section: Management/treatmentmentioning

confidence: 99%

Section: Fukuda Research Case Definition For Chronic Fatigue Synmentioning

confidence: 99%

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer

Underhill²,

et al. 2017

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“…The drug can be effective for neurally mediated syncope and for POTS (Level I evidence). Clonidine is a central sympatholytic agent that can be useful if there is comorbid anxiety, and can be useful in patients with the central hyper adrenergic form of POTS [Robertson et al, ]. Selective serotonin reuptake inhibitors or serotonin‐norepinephrine reuptake inhibitors can be helpful in some patients with OI, and can be beneficial in the setting of co‐morbid pain, anxiety, or depression [Di Girolamo et al, ]. Dihydroxyphenylserine titrated 100–200 mg three times daily reduces OH (Level I evidence). Octreotide given subcutaneously in doses of 25–150 μg for 30 min before a meal may be used to reduce postprandial OH. Tolerance of upright posture and autonomic tone may improve after the administration of 1–2 L of intravenous normal saline infused over 1–2 hr [Burklow et al, ; Takenaka et al, ], or other forms of sodium loading [Rosen and Cryer, ]. Some physicians use IV saline to manage acute episodic exacerbations of OI [Moak et al, ].…”

Section: Management and Care Guidelinesmentioning

confidence: 99%

Cardiovascular autonomic dysfunction in Ehlers–Danlos syndrome—Hypermobile type

Hakim¹,

O’Callaghan²,

Wandele³

et al. 2017

American J of Med Genetics Pt C

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Autonomic dysfunction contributes to health-related impairment of quality of life in the hypermobile type of Ehlers-Danlos syndrome (hEDS). Typical signs and symptoms include tachycardia, hypotension, gastrointestinal dysmotility, and disturbed bladder function and sweating regulation. Cardiovascular autonomic dysfunction may present as Orthostatic Intolerance, Orthostatic Hypotension, Postural Orthostatic Tachycardia Syndrome, or Neurally Mediated Hypotension. The incidence, prevalence, and natural history of these conditions remain unquantified, but observations from specialist clinics suggest they are frequently seen in hEDS. There is growing understanding of how hEDS-related physical and physiological pathology contributes to the development of these conditions. Evaluation of cardiovascular symptoms in hEDS should include a careful history and clinical examination. Tests of cardiovascular function range from clinic room observation to tilt-table assessment to other laboratory investigations such as supine and standing catecholamine levels. Non-pharmacologic treatments include education, managing the environment to reduce exposure to triggers, improving cardiovascular fitness, and maintaining hydration. Although there are limited clinical trials, the response to drug treatments in hEDS is supported by evidence from case and cohort observational data, and short-term physiological studies. Pharmacologic therapy is indicated for patients with moderate-severe impairment of daily function and who have inadequate response or tolerance to conservative treatment. Treatment in hEDS often requires a focus on functional maintenance. Also, the negative impact of cardiovascular symptoms on physical and psycho-social well-being may generate a need for a more general evaluation and on-going management and support.

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“…Restoration of plasma volume improves the condition (Takenaka et al 2002), but the observation that only a single day of bed rest reduces sympathetic nerve responses to lower body negative pressure does not support that cardiac “atrophy” is the primary mechanism (Khan et al 2002). However, it remains debated whether orthostatic intolerance after bed rest is related to insufficient increase in sympathetic discharge in response to a greater postural reduction in stroke volume (Shoemaker et al 1999; Levine et al 2002; Khan et al 2002; Ertl et al 2002; Kamiya et al 2003; Eckberg 2003).…”

Section: Microgravity and Bed Restmentioning

confidence: 99%

A definition of normovolaemia and consequences for cardiovascular control during orthostatic and environmental stress

2010

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The Frank–Starling mechanism describes the relationship between stroke volume and preload to the heart, or the volume of blood that is available to the heart—the central blood volume. Understanding the role of the central blood volume for cardiovascular control has been complicated by the fact that a given central blood volume may be associated with markedly different central vascular pressures. The central blood volume varies with posture and, consequently, stroke volume and cardiac output () are affected, but with the increased central blood volume during head-down tilt, stroke volume and do not increase further indicating that in the supine resting position the heart operates on the plateau of the Frank–Starling curve which, therefore, may be taken as a functional definition of normovolaemia. Since the capacity of the vascular system surpasses the blood volume, orthostatic and environmental stress including bed rest/microgravity, exercise and training, thermal loading, illness, and trauma/haemorrhage is likely to restrict venous return and . Consequently the cardiovascular responses are determined primarily by their effect on the central blood volume. Thus during environmental stress, flow redistribution becomes dependent on sympathetic activation affecting not only skin and splanchnic blood flow, but also flow to skeletal muscles and the brain. This review addresses the hypothesis that deviations from normovolaemia significantly influence these cardiovascular responses.

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Effects of rapid saline infusion on orthostatic intolerance and autonomic tone after 20 days bed rest

Cited by 14 publications

References 11 publications

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer

Cardiovascular autonomic dysfunction in Ehlers–Danlos syndrome—Hypermobile type

A definition of normovolaemia and consequences for cardiovascular control during orthostatic and environmental stress

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