Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome

Snapper, Howard; Cheshire, William P.

doi:10.1016/j.autneu.2022.102951

Cited by 7 publications

(5 citation statements)

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“…Nevertheless, the intake of 500 ml water was not only associated with a decrease in heart rate during head-up tilt, but also with a decrease in overall symptoms and specifically also in brain fog ("difficulty concentrating"). Both results confirm previous findings of the beneficial effect of water drinking on orthostatic tachycardia and symptoms of orthostatic intolerance (Jacob et al, 1997;Gordon et al, 2000;Z'Graggen et al, 2010;Rodriguez et al, 2019;Snapper and Cheshire, 2022).…”

Section: Discussionsupporting

confidence: 91%

“…In our previous study, we confirmed that working memory performance is impaired in neuropathic POTS during head-up tilt compared to the supine position, as well as compared to the performance of healthy subjects, and showed that this deficit improved after ingestion of half a liter of water (Rodriguez et al, 2019). The improvement in cognitive performance was paralleled by a reduction in heart rate increase and subjective symptom perception, both known effects of water 10.3389/fnins.2022.968725 intake in POTS (Jacob et al, 1997;Gordon et al, 2000;Shannon et al, 2002;Z'Graggen et al, 2010;Snapper and Cheshire, 2022). Fittingly, Ross and colleagues showed that 86% of patients reported reduced fluid intake as a trigger of cognitive dysfunction and that treatment with intravenous saline improved cognitive performance (Ross et al, 2013).…”

Section: Introductionsupporting

confidence: 84%

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Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking

et al. 2022

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BackgroundBrain fog is a common and highly disturbing symptom for patients with neuropathic postural tachycardia syndrome (POTS). Cognitive deficits have been measured exclusively in the upright body position and mainly comprised impairments of higher cognitive functions. The cause of brain fog is still unclear today. This study aimed to investigate whether increased autonomic activation might be an underlying mechanism for the occurrence of brain fog in neuropathic POTS. We therefore investigated cognitive function in patients with neuropathic POTS and a healthy control group depending on body position and in relation to catecholamine release as a sensitive indicator of acute stress. The second aim was to test the effect of water intake on cardiovascular regulation, orthostatic symptoms, cognitive function and catecholamine release.MethodsThirteen patients with neuropathic POTS and 15 healthy control subjects were included. All participants completed a total of four rounds of cognitive testing: two before and two after the intake of 500 ml still water, each first in the supine position and then during head-up tilt. At the end of each cognitive test, a blood sample was collected for determination of plasma catecholamines. After each head-up tilt phase participants were asked to rate their current symptoms on a visual analogue scale.ResultsWorking memory performance in the upright body position was impaired in patients, which was associated with self-reported symptom severity. Patients had elevated plasma norepinephrine independent of body position and water intake that increased excessively in the upright body position. The excessive increase of plasma norepinephrine was related to heart rate and symptom severity. Water intake in patients decreased norepinephrine concentrations and heart rate, and improved symptoms as well as cognitive performance.ConclusionBrain fog and symptom severity in neuropathic POTS are paralleled by an excessive norepinephrine secretion. Bolus water drinking down-regulates norepinephrine secretion and improves general symptom severity including brain fog.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionsupporting

confidence: 84%

Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking

et al. 2022

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“…This may start a negative spiral since gastrointestinal symptoms of diarrhea and vomiting may worsen dehydration and electrolyte imbalance with the loss of potassium and albumin. The sympathetic activation continues until the patient is supine, or until the patient increases plasma volume through hydration [38]. In accordance with the hypovolemia theory, POTS patients experienced a reduction in heart rate acceleration and standing plasma norepinephrine upon upright position following a short-term period of elevated dietary sodium intake [27].…”

Section: Discussionmentioning

confidence: 84%

“…The decreased return of blood to the heart and the reduced cardiac output lead to less stimulation of carotid and aortic baroreceptors, triggering an increase in sympathetic outflow [36,37]. The high sympathetic activity renders a hyperadrenergic state with palpitations, tachycardia, near syncope, chest pain, and dyspnea, as well as symptoms from other organs like the gastrointestinal system, the genitourinary system, and psychological effects of high sympathetic activity such as anxiousness [38]. This may start a negative spiral since gastrointestinal symptoms of diarrhea and vomiting may worsen dehydration and electrolyte imbalance with the loss of potassium and albumin.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic Factors, Nutritional Status, and Inflammatory Markers in Patients with Postural Orthostatic Tachycardia Syndrome

Tufvesson

Hamrefors

Roth

et al. 2023

Acta Neurologica Scandinavica

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Objectives. Postural orthostatic tachycardia syndrome (POTS) is characterized by cardiovascular autonomic dysfunction of unknown etiology with high a prevalence of gastrointestinal symptoms. The aim of the present study was to examine sociodemographic, lifestyle, and nutritional factors as well as inflammatory markers in patients with POTS. Materials and Methods. Forty-three patients with POTS and 61 healthy controls completed questionnaires about sociodemographic factors, lifestyle habits, and gastrointestinal symptoms. Blood samples were analyzed for serum levels of cobalamins, folic acid, iron, total iron-binding capacity (TIBC), ferritin, sodium, potassium, magnesium, phosphorus, albumin, high-sensitive C-reactive protein (CRP), and 25-hydroxyvitamin D (25-OH vitamin D). Results. POTS patients were predominantly women with a lower education level and were more often working part-time, on sick leave, and living alone compared with healthy controls. They reported lower alcohol intake and physical activity levels than controls. The nutrient intake was in general similar in both groups, but POTS patients had a higher intake of different drinks and reported more gastrointestinal symptoms than controls. POTS was associated with higher CRP levels (β: 1.370; 95% CI: 0.004–2.737; p = 0.049 ), lower albumin levels (β: -1.443; 95% CI: -2.648–(-0.238); p = 0.019 ), and higher sodium levels (β: 1.392; 95% CI: 0.559–2.225; p = 0.001 ). Abdominal pain ( p = 0.004 ) and intestinal symptoms’ influence on daily life ( p = 0.025 ) were negatively associated with albumin levels. Abdominal pain ( p = 0.011 ), vomiting and nausea ( p = 0.003 ), and intestinal symptoms’ influence on daily life ( p = 0.026 ) were associated with higher sodium levels. Serum levels representing iron and vitamin metabolism were equal between groups. Conclusions. POTS is associated with poorer sociodemographic status, but malnutrition cannot explain POTS or related gastrointestinal symptoms. Higher CRP and lower albumin levels suggest low-grade inflammation as one possible etiological factor.

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“…For bladder management, we planned CIC at least 4 times/day, followed by self-voiding. Because she had been diagnosed with cervical spinal cord myelopathy, we encouraged a total fluid intake of approximately 2000 mL/day to prevent orthostatic hypotension[ 8 ].…”

Section: Case Presentationmentioning

confidence: 99%

Tamsulosin-induced life-threatening hypotension in a patient with spinal cord injury: A case report

Lee¹,

Lee²,

Park³

et al. 2022

WJCC

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BACKGROUND Tamsulosin, a selective α1-adrenergic receptor antagonist, is commonly used for treating neurogenic bladder in patients with spinal cord injury (SCI). No severe adverse events have been described with such tamsulosin use. To our knowledge, we report the first case of severe life-threatening hypotension as an adverse effect of tamsulosin in a person with SCI. Therefore, we report this case to inform that this severe adverse effect of tamsulosin can occur when treating patients with SCI. CASE SUMMARY A 59-year-old woman was diagnosed with cervical spinal cord myelopathy and was classified as American Spinal Injury Association Impairment Scale D, neurological level of injury C3. Because she suffered from voiding difficulty due to neurogenic bladder, we prescribed tamsulosin. Her vital signs remained stable, but occasional hypotensive symptoms followed defecation. We reduced the dose of tamsulosin, but after administering tamsulosin for 9 d, she experienced life-threatening hypotension with no evidence of hypovolemic shock, neurogenic shock, cardiogenic shock, or septic shock. A hypotensive condition induced by tamsulosin was the suspected cause, and her symptoms could be associated with adverse effects of tamsulosin. As symptoms resolved after stopping tamsulosin, and no other reason was found, we concluded that tamsulosin was the cause of her symptoms. CONCLUSION Caution for severe hypotension is needed when administering tamsulosin for neurogenic bladder in a patient with SCI.

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Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome

Cited by 7 publications

References 83 publications

Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking

Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking

Sociodemographic Factors, Nutritional Status, and Inflammatory Markers in Patients with Postural Orthostatic Tachycardia Syndrome

Tamsulosin-induced life-threatening hypotension in a patient with spinal cord injury: A case report

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