The Benefits of Oral Rehydration on Orthostatic Intolerance in Children with Postural Tachycardia Syndrome

J Pediatr. 2019 Nov;214:96-102. doi: 10.1016/j.jpeds.2019.07.041. Epub 2019 Aug 9.

Abstract

Objective: To evaluate whether equal volumes of oral rehydration solution (ORS) or intravenous (IV) saline provide similar improvements in cardiovascular status during controlled orthostatic challenge when administered to subjects with postural tachycardia syndrome (POTS) with orthostatic intolerance.

Study design: We studied the neurovascular response to fluid loading during orthostatic stress using lower body negative pressure (LBNP) in 10 subjects with POTS with orthostatic intolerance and 15 controls, and on subsequent days before and 1 hour after IV saline infusion or ingestion of ORS.

Results: Subjects with POTS exhibited reduced tolerance to LBNP (P < .0001) compared with controls (Orthostatic Index of 35 715 ± 3469 vs 93 980 ± 7977, respectively). In POTS, following ORS but not saline infusion, cerebral blood flow velocity (CBFv) was significantly higher than that with no treatment, at -45 mm Hg (P < .0005). Although fluid loading did not confer any advantage in controls, subjects with POTS experienced a significant improvement in orthostatic tolerance following both saline infusion (100 ± 9.7 vs 134.5 ± 17.4; P < .05) and ORS (100 ± 9.7 vs 155.6 ± 15.7; P < .001) when evaluated by normalized orthostatic index (P < .001, compared with untreated baseline).

Conclusions: Maintenance of CBFv may have resulted in the improved short-term orthostatic tolerance exhibited by the subjects with POTS following ORS administration. ORS is a convenient, safe, and effective therapy for short-term relief of orthostatic intolerance.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Case-Control Studies
  • Female
  • Fluid Therapy / methods*
  • Humans
  • Infusions, Intravenous
  • Male
  • Postural Orthostatic Tachycardia Syndrome / therapy*
  • Rehydration Solutions / therapeutic use
  • Saline Solution / therapeutic use
  • Treatment Outcome
  • Young Adult

Substances

  • Rehydration Solutions
  • Saline Solution