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dehydration_womanBottle.jpg.91b675d31d97bad1ef17f032dcbe500f.jpgby Margaret Rose Lombardi

Being adequately hydrated isn’t just an important part of physical health for people with POTS and other forms of dysautonomia.  Without proper hydration, anyone's body can experience severe damage and even death. Knowing the signs and symptoms of dehydration for yourself and your family is critical during the summer months.

Feeling thirsty is the least reliable way to tell if a person has enough fluid in their body.  Many people don’t feel thirsty until they are already dehydrated.


  • Dizziness
  • Extreme thirst
  • Not urinating at all, urinating infrequently, or urinating very small amounts
  • Dark colored urine with a strong odor
  • Fatigue
  • Feeling confused or acting “spaced out”

In Babies and Small Children

  • Dry mouth and tongue - lips sticking together
  • No urination or wet diapers for three hours
  • Extreme tiredness or irritability
  • Eyes and cheeks looking “hollowed out” or “sunken”
  • Indentation of the soft spot on top of the head (infants)

For both children and adults, dehydration is possible in hot weather, during exercise, and during illnesses, particularly if the person has diarrhea, vomiting or fever.  

Dehydration can cause extreme damage to the healthiest of people, including:

  • Heat stroke, cramps, and heat exhaustion
  • Urinary and kidney damage - including kidney failure
  • Seizures - potassium and sodium (electrolytes) can become too low causing seizures.  Electrolyte imbalance can also cause involuntary muscle contractions and unconsciousness.
  • Hypovolemic Shock - low blood volume causes a drop in BP and the amount of O2 in the body.

Why does dehydration affect POTS patients more than the average person?

For POTS and many other dysautonomia patients, the mechanism that regulates BP and HR when a person stands up is dysfunctional (BP goes down, HR goes up).  Water intake counteracts this response, helping the symptom that leads to dizziness, pre-syncope, and syncope. Water intake can help to  minimize BP’s reaction to standing in most patients.

In understanding the effect increased water intake can have on the symptoms associated with POTS and Dysautonomia, it is easy to understand how drinking just an average amount of water isn't enough and won't necessarily prevent symptoms.

It is extremely important, truly critical to understand that although the results of dehydration will be similar for POTS dehydration_waterbottle.jpg.773e2775cdf50b8014734321bcb3322d.jpgpatients as it is for the healthy person, the steps to becoming dehydrated should not be underestimated. Excessive sweating is another of the functions of the autonomic nervous system that is dysfunctional in a person living with dysautonomia.  Because of this, a person with these disorders can dehydrate regardless of the outside temperature. Couple this symptom with the body’s reaction to high summer heat and a potentially dangerous picture emerges.

The recommended way most POTS patients protect themselves from dehydration is by maintaining a combination of salt intake and electrolyte-rich drinks - all under the supervision of their physician.  This is a crucial part of management that can’t be ignored, especially during the lazy, hazy days of summer.

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Just wanted to add to this that urine volume and colour are not necessarily good indicators of hydration in POTS patients due to deficient fluid retaining hormones, ie the principle that if your urine is pale you are adequately hydrated cannot automatically be applied to us.

The urine volume/colour method of assessing hydration only holds true in patients who are able to adequately conserve fluid at the renal level. 

B xxx

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How much Gatorade should one drink? What it too little? I drink so much water and Gatorade I never know how much of which one to do

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I am recently diagnosed. I found that I need to drink Gatorade but also need more salty drinks and food to help retain the fluid in my system. 
I drink 2 cups of soup broth for breakfast followed by 32 ounces of Gatorade and eat salty snacks throat the day. That’s what’s working for now. I think everyone is different. 
it’s a balance of salt and water that’s going to help maintain bp. 

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