Any Research/ References On Why Iv Fluid Works For Pots?

[persephone]

Hello; I know we almost all get hugely better on IV fluids. Can anyone post a link or reference to some paper/research on WHY or HOW that is?

I've proved yet again today how much of a difference IV fluid makes- I went from 155 standing to 100.

Now my team are saying they don't know why it makes such a difference to have IV fluid compared to drinking. I don't know either. But what I do know is that it works.

If anyone could help me out, I'd really appreciate it. My attending would want to see this by tomorrow pm I guess.

[Heiferly]

Have you tried searching on pubmed and google scholar? That's where I got all the journal articles that I gave my doc as references for this to give to my insurance. There are a TON of them. Here are the links to pubmed and google scholar if you don't have them:

http://scholar.google.com/

http://www.ncbi.nlm.nih.gov/pubmed/

Here's what I sent my doc, but seriously you can find more. I just gave up after I felt like I had gotten enough, but if you think you need more ... go fish. Good luck with your doctor!

Here's an article describing a (successful) clinical trial of saline IV on POTS (referred to as "idiopathic orthostatic tachycardia" here, but seems to be POTS?) from Vandy's bigwig, Dr. Robertson (et. al.):

http://circ.ahajournals.org/cgi/content/full/96/2/575

IV Saline for POTS discussed here under "Non-Pharmacological Treatment of POTS:"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1501099/

Not a free article, and I don't currently have a copy of it to read beyond the abstract, but here's a Mayo study on POTS that included IV saline as one of the tested interventions:

http://www.springerlink.com/content/h4152621g7324743/

Here's NCS and IV saline in a clinical trial:

http://content.onlinejacc.org/cgi/content/full/33/7/2059

IV saline in another clinical trial of NCS:

http://archpedi.ama-assn.org/cgi/content/full/152/2/165

This one shows how IV saline improves cerebral blood flow in POTS/IOI (not sure if Vandy switched terms at some point, because I'm pretty sure they use the term POTS today). From the article: "The main novel finding of this study is that ... volume loading [with 2L saline infusion] ... attenuate the decrease in mean MCAvel [middle cerebral blood flow velocity] with HUT in patients with IOI."

http://hyper.ahajournals.org/cgi/content/full/32/4/699

I don't have full access to this, but it looks rather promising. First, it is published in CAR (Clinical Autonomic Research) which is "our" journal for dysautonomia. Second, it addresses the issue of oral fluid intake being inadequate: "In orthostatic intolerance patients, water drinking blunts the orthostatic tachycardia but has only a modest effect on blood pressure." Hopefully this can bolster the case that getting the fluids in *by IV* is what is needed to get my pressure up enough to bring me meaningful symptom improvement! I wish I had full access to this article to see exactly what all it says, but it definitely looks promising (in combination with the others above, of course):

http://www.springerlink.com/content/w2mnba8jg9nv8w1m/

Other research that may be of note:

From abstract: "In patients with idiopathic orthostatic intolerance, peak and mean middle cerebral artery blood flow velocity decreased in response to head-up tilt despite well sustained arterial blood pressure. These observations indicate that in this group of patients, regulation of cerebrovascular tone may be impaired and might therefore be a target for therapeutic interventions." I think this is the key to understanding why achieving normovolemia is insufficient for (some?) patients with dysautonomia. If you recall, [name of one of my docs removed for my privacy] remarked that I was maintaining at about normovolemic with the fludrocortisone and fluid (2L/day) and sodium (5000 mg/day) loading, but that ideally he would like to see my volume still increased somewhat. This makes sense (at least to this layperson) if you think of it in terms of the arterial pressure not being reflective of the cerebral perfusion; by increasing volume further, the symptoms of cerebral hypoperfusion seem to be alleviated, as I have found to be the case in the past when receiving IV saline in addition to the oral fluids/salt loading/fludrocortisone.

http://www.amjmed.com/article/S0002-9343%2898%2900364-7/abstract

[Heiferly]

Sorry, I should have mentioned ... it may be useful for you to know that the research grants are mainly being funneled through Vanderbilt. As far as I know, they've done the bulk of the research on IV saline and OI dysautonomias. They had a current study running on it a while back ... don't know if it's still ongoing or not but you may want to look on the NIH's website to see if that is still going on or not. You can search their clinical trials for it to see if it has ended or not. Send me a private message if you have any other questions ... I'll try to keep an eye out for one (don't know if I'd see a reply in this thread in a timely manner).

[MightyMouse]

Pers, I can usually get full text articles for the ones that are offered as paid subscription--Email or PM me with the citations you'd like (title, authors, year). I'm late with my tuition at grad school though, so sometimes they suspend my account until it's paid in full. For now, your doctors at the hosp should all have full access or at least get the gist of the article(s) from the abstract. You can search PubMed for abstracts too

http://www.ncbi.nlm.nih.gov/pubmed/