Body Holding On To Iv Fluids, But Not Oral

[Lethargic Smiles]

If you don't want to read my long post, just skip to the last little paragraph for my bottom line question. Any and all theories, or even a "Hey that happens to me too!" are appreciated!

Background:

Intuitively, before I was diagnosed with POTS, I drank large amounts of water. I was just always thirsty. Like many POTS patients, upon my diagnosis I was encouraged to up my fluid intake and up my sodium as well to help me hang on to the water. I didn't up my fluid intake too much because I already drank so much, but I did start consuming more sodium. I've had the 24 hour urine collection sodium done, and through that, found out I wasn't getting enough sodium and was likely washing out the sodium I did have with excessive water intake. This was believed to be the reason no matter how much water I drank, I was thirsty and it just washed right through me. My sodium levels are now in the normal range, although still in the middle of the lower end.

Current Intakes:

I don't like sports drinks and the like because of the sugar and I don't use any "no calorie" artificial or natural sweeteners either. That takes out many electrolyte products. I get my sodium through adding sea salt to food, broth, and tomato juice. Over the first few hours of each day, I get in 2670 mg of sodium and 1.75 liters of water. I drink about another 1.5-2.5 liters throughout the day. I go by my thirst level, by the how often I'm urinating, and the color of the urine. I eat potassium rich foods in order to balance out all of this sodium. Most days, this regimen works for me. I know some don't agree with the sodium regimen. In my case, it has significantly helped me hang on to water better most days.

Concern:

Some days, I seem to not hold on to oral fluids no matter how much sodium I consume or fluids I drink. I begin to feel dehydrated in many ways despite having plenty to drink. Based on my notes, it doesn't seem to be related to excessive fluid intake the day before or medications. I rarely consume caffeine. Sometimes, it does seem to be correlated to more exertion than my normal low level, but not always. The day following days like this, or sometimes the day of, I end up getting IV fluids. Something that strikes me is that on these days, if I'm not nauseous, I'll drink and drink oral fluids, but they go right through me. I then get 2 liters of IV fluids, and I will not pee for hours. If I end up getting fluids at night, I'll go to bed without visiting the bathroom until morning. I never noticed this pattern until recently because I used to only go get IV fluids if I was vomiting, so I wasn't taking in any oral fluids those days usually. Now I get them more frequently.

Bottom Line/My Question:

Why, on some days, will my body hold on to 2 liters of IV fluids after choosing to let oral hydration go right through all day long to the point of me feeling dehydrated? I know saline (.9%) is formulated to be something the body easily holds on to, but I don't understand how my body can be so dehydrated that it will easily hold on to 2 liters of IV fluids after having oral fluids available all day long. I would think I'd have to pee after having 2 liters infused into my bloodstream, but I don't.

[Chaos]

I have heard a couple different theories on this. One given to me by an ex-ICU/CCU nurse was that the IV fluid gets into different "spaces" (vascular beds?) than the oral fluids do. Argh, there is another word that I am forgetting there that I want to use but can't think of now.

The second theory has to do with the whole Renin/Angiotensin/Aldosterone cycle that they have found to be "off" in some POTS patients whereby we don't retain fluids normally out of the kidney. That explains why many of us tend to run a litre or so low on fluids. Not sure if it's part of the same theory or a third theory that the autonomic neuropathy some of us have affects the kidneys' ability to retain fluids as well. Therefore putting fluids directly into the vascular spaces tends to work better for some folks.

It is frustrating when you drink so much and don't feel like you have much to show for it. I know I always feel kind of silly going in for IV's and always want to explain to the nurses that I'm really not just lazy or not drinking.

[yogini]

There are lots of factors (hormonal, etc), but if you are drinking throughout the day, you are probably urinating them out at the same rate you are drinking. With an IV your body is forced to absorb some of the water. Mayo told me to drink 2 bottles of water in a row, which is supposed to have a similar effect. IV fluids are a temporary fix, since you will eventually pee them out

I've heard that recommended total fluid intake is around 1.5-3 liters; drinking too much washes out electrolytes. 4 liters plus broth, tomato juice etc may be too much - your dr would really be able to tell you.

[E Soskis]

I tried to drink over 100 ounces of fluid a day (at least) and felt like I was always sloshing around. I found that due to the GI issues of dysautonomia, I have irregular absorption of food and fluids. IV fluids directly fill up the vasculature without having to go through the GI absorption process. It is a temporary fill though. The blood flows through the kidneys and therefore, the IV fluids end up going through the kidneys and subsequently urinated out....Remember, our vasculature is very floppy and does not constrict like it should - it takes more fluids to "fill up" the pipes - probably one reason IV fluids work so well.....

[Lethargic Smiles]

Thanks guys. I'm still pretty confused, but it sounds as though no one is quite clear on this issue, so at least I am not alone, definitely have some new thoughts to research further.

I'm especially interested in the kidney issues aspect as I had kidney issues as a child and a family member with kidney issues. The potential hormonal aspect is also interesting to me as I have a history of some of my hormones (although none of those mentioned) being out of whack. My DHEA level at 21 was that of an 80 year old woman. Now it stays level without a supplement. I don't know if this former problem could be related at all to the hormones involved in fluid retention or not as I've never researched this area in relation to fluid retention.

Chaos -- Is there any sort of testing people have had done for Renin/Angiotensin/Aldosterone issues, and if there are issues in this area, are there any remedies? I know I've seen this topic covered on threads, so perhaps I'll scour the forums when I'm feeling up to it to learn more.

Just to clarify, when I said I drink 1.75 liters of "fluid" in the morning, this includes broth, tomato juice, almond milk, etc., I didn't mean 1.75 liters of purely water in addition the other drinks. I do 24 hour urine screenings sometimes to make sure my sodium isn't being washed out and also electrolyte checks, and so far, everything seems to stay in balance. If I drink anything less than 3 liters of fluid in a day, it results in a flare up of symptoms. Just for whatever reason, on particular days, my body won't hang on to oral fluids, but will easily hang on to IV fluids.

[Lethargic Smiles]

Chaos, I maybe came across what the nurse was talking about. I need to finish reading the article but my brain is not cooperating!

"When the movement of water causes a concentration difference, the cells either shrink or swell, depending on the direction of the net movement.Isotonic solutions (0.9% saline) do not cause cells to either shrink or swell. Hypertonic solutions (one with greater than 0.9% saline) cause cells to shrink by moving water from within the cell to the ECF compartment, which has less sodium than the cell. Hypotonic solutions (such as 5% dextrose and 0.2% normal saline) cause cells to swell." LINK (Chapter on Fluid and Electrolyte Regulation -- geared toward people working in pediatrics, but much is applicable and the author indicates when something is mainly applicable to children)

So I suppose that would be the difference between consuming sodium and water versus the 0.9% solution I am giving through an IV. I wonder why it would mater that the solution does not cause the cell to shrink or swell and consumption of sodium/water does?

Any ideas or direction I should be looking anyone?

[Lethargic Smiles]

More from the article I linked above.

"Regulation and distribution of sodium and potassium within the interstitial and the intracellular fluid compartments are via the sodium potassium pump. Active transport is necessary to move sodium from the cells to the ECF compartment. The active process of pumping sodium out of the cells forces potassium into the cell. An example of the effects of the sodium-potassium pump is seen in children with severe bums. The injury causes more sodium than water to be drawn into the interstitial spaces.

This decreases the efficiency of the sodium pump, which allows more water and sodium to enter the intracellular space. The increased osmotic pressure gradient drives
potassium out of the cell. The loss of water and sodium from the intravascular space results in the increased secretion of aldosterone and antidiuretic hormone (ADH) as compensatory
mechanisms, which contributes to the retention of sodium and water.

Not only is energy required to move substances against a concentration gradient, but a carrier substance is required for the transport of sodium, potassium, chloride, sugars, and amino acids. Carrier substances are either a protein or a lipoprotein. The protein carriers function by providing an attachment site for the specific substance to be transported. The lipoprotein facilitates the solubility of the substance in the lipid portion of the cell membrane."

According to the chapter, there are 4 different ways for fluids to move around. The article is geared toward pediatrics, but this is true of all of us. The above is one way... So, in addition to the Renin/Angiotensin/Aldosterone cycle theory, it seems like there are plenty of chances for things to go wrong just with fluid/electrolyte exchange within the cells and maybe that could explain why IV fluids, which don't require any exchange of fluids from inside or outside the cell, bypass this problem. I'm a layman though, so who know -- could be understanding it completely wrong!

[Alison]

I'm reading this all with interest. Like you, I feel that I just don't hold onto fluids, I drink and then go to the toilet. I too have been thinking that my body doesn't balence sodium properly. A normal person's body would just sort itself out whatever you ate and drank (within reason). I think I can sense when I have drank too much water - I feel funny in the head. I've decided to reduce slightly.

[Lethargic Smiles]

I'm like you Alison where I can tell when I've drank too much and maybe need some sodium and to drink less the next day. Luckily this doesn't happen too often anymore because I've got a routine down my body agrees with.

I also get this really weird sense when I need IV fluids. It doesn't feel like dehydration, but I can't really explain what it DOES feel like. When I've gone and gotten them when I feel cruddy overall, but don't have "the feeling", they haven't been near as beneficial.

[kayjay]

I'm not confident that I can help but I will tell you that Mayo told me no more than 50% free water. I was crazy thirsty for so long and drank too much. I ended up in the er several times with moderately low sodium

I know it's not cheap but if you can drink pedialyte or v8 for a week you may notice a difference.

I almost cried when I read your post, I remember the misery. Now that I drink less water and more salty drinks I am so much better.

[Chaos]

I came across some notes last night that I made after watching one of Dr. Raj's videos in the past. He was wondering if perhaps the kidneys in POTS patients aren't able to hold onto sodium for some reason. Don't have time to write more right now but will try to remember to get back to you on this. But if I forget, please PM me to remind me.

[Becia]

All i know is I drink and it goes right through me within 15 minutes, no matter how little I drink at a time, spread out over whatever time. I have IV hydration, and I'm not losing it nearly as fast, and I feel 10 times better.

[Lethargic Smiles]

Thanks kJay. That is what I do when I get the feeling things are going out of whack (increase my broth intake) but it doesn't do the trick for me. Maybe if I did it more regularly like you do I wouldn't get out of whack in the first place though. I went to Mayo too but they told me to monitor my 24 hour urine collections and adjust my sodium and fluid/water intake based on that. My blood sodium which gets measured more frequently is also good although I know it isn't an accurate measure like the urine analysis is.

Chaos -- I will be interested to hear what you are able to recall!

Becia -- I'm with ya! I wish there was an answer as to why some of us are like this despite adequate sodium and other electrolyte intake.

[Suthrngal]

Great info here. I drink, it comes out. Always has. Keep testing low in sodium. Even tho I salt load as per MAYO. mAYO did not Rec. iv's but it was after an iv in the ER that confirmed to me the high hr, low Bp, dizziness and blocked intestines were all related. Who here is helped by iv's?

I definately have a kidney issue involved. All of you mention this....what do we do about it? Just up fluids/salt???

And plz see comment below as my most annoying symptom now is neuropathy in legs and feet! Seems to be related to times of blocked intestines although can't confirm! Pins and needles! But only sometimes but significant. Someone mentions this below.

"The second theory has to do with the whole Renin/Angiotensin/Aldosterone cycle that they have found to be "off" in some POTS patients whereby we don't retain fluids normally out of the kidney. That explains why many of us tend to run a litre or so low on fluids. Not sure if it's part of the same theory or a third theory that the autonomic neuropathy some of us have affects the kidneys' ability to retain fluids as well. Therefore putting fluids directly into the vascular spaces tends to work better for some folks."

[SarahA33]

Hi Jackie,

Its been a while since I've said hello, I'm hoping things are going well for you.

In regards to the fluid retention, I have the exact same problem. Sometimes I'll get fluids once or twice a ,2 -4 liters each month because my body litterely ***** it up". Like yourself, I won't pee for almost 2 days. It's incredibly frustrating.

I do have to agree with Kayjay regarding the V8 or pedialite. At this point i've been able to get away with splitting half gatoraide and half water..