Tuesday, May 16, 2017

Intravenous Hydration For POTS/Dysautonomia

Dysautonomia is a term defining conditions impacting the autonomic nervous system. The autonomic nervous system controls every bodily function occurring "automatically." A subset of Dysautonomia is Postural Orthostatic Tachycardia Syndrome (POTS), effecting a body's ability to regulate upon postural positional changes. Because of POTS, blood is unable to reach the brain when transitioning from laying to sitting or sitting to standing.

Read STOP POTS? to learn about Postural Orthostatic Tachycardia Syndrome.

POTS primarily manifests with a multitude of cardiac symptoms:

  • Tachycardia (high heart rate)
  • Bradycardia (low heart rate)
  • High blood pressure
  • Low blood pressure
  • Blackouts (pre syncope)
  • Fainting (syncope)
  • Blood pooling
  • Fatigue
  • Dizziness
  • Lightheadness
  • Excessive sweating
  • Shortness of breath
  • Headaches

The majority of POTS patients suffer from a high heart rate and low blood pressure. Since it is a dysfunction of the nervous system, symptoms can range from one extreme to another, similar to constantly flipping a hypothetical on/off switch in the body.

Sodium and fluid regulate the unstable pulse and blood pressure. To combat the debilitating symptoms, it is recommended that a POTS patient consumes 3 to 10 grams of salt and over 2 liters of fluid daily. [ x ] [ x ] That intake is difficult. In severe cases, the amounts needed to control symptoms are impossible without the support of IV saline therapy through a central line. That is why some resort to IV saline therapy! 

"How much saline do you run?"

For the treatment of POTS/Dysautonomia alone, 1 to 2 liters is typically infused at a time.

"How frequently do you infuse the fluids?"

The frequency of administering saline is dependent on the medical situation. If the patient is physically able to obtain adequate hydration normally, liters of saline do not necessarily have to be infused daily. The supplemental hydration for POTS/Dysautonomia treatment can be spread out to 3 to 4 times a week.

"What symptoms does it improve?"

Saline infusions help fight the miscellaneous symptoms stemming from POTS cardiac involvement, low blood volume, and dehydration. It helps with the following the most:

  • Dizziness
  • Lightheadedness
  • Presyncope/Syncope (fainting)
  • Tachycardia
  • Fatigue

"How is this different than drinking fluids orally/via feeding tube?"

Receiving intravenous saline is superior to simply drinking fluids in improving symptoms. 

The following can influence the success of IV saline.

  • Sodium Content
A high sodium content is necessary in combination with fluids to benefit symptoms, such as increasing blood pressure and decreasing the heart rate. Since regular water lacks the sodium saline has, it is less effective. 

"Why not drink Gatorade and/or electrolyte drinks?"

Gatorade, Powerade, Pedialyte, and other electrolyte drinks can be helpful. However, they contain large amounts of sugars, dyes, and additional ingredients. The additives are not ideal in excess, like a POTS patient requires. The healthier homemade options still contain sugars to taste, which are still less palatable in large quantities.

  • Gastrointestinal Distress
While POTS encompasses the cardiac symptoms of Dysautonomia, the majority of patients have symptoms in other bodily systems. Whether caused directly from the Dysauotnomia or from another primary or secondary health condition, the gastrointestinal tract is often effected. Nausea, vomiting, acid reflux, and diarrhea are common symptoms. Stressing the body by ingesting a high volume of water exacerbates the GI complaints.

A Mast Cell Disease Perspective 

Some patients with POTS/Dysautonomia have a Mast Cell Disease. The unstable mast cells in patients with Mast Cell Disease are known to result in secondary Dysautonomia. So, the involvement in the autonomic nervous system is actually a symptom of the Mast Cell Disease! The above information regarding saline therapy for POTS still applies.

It is important not to confuse the symptoms of POTS with other cardiac symptoms of Mast Cell Disease. If experiencing such symptoms laying down, it is likely not POTS in that moment because POTS is triggered from POSTURAL changes.

However, Mast Cell Disease presents unique circumstance that may change the response to IV hydration therapies.

"Can IV hydration help MCAD symptoms?"

Aside from POTS, intravenous hydration is helpful in other ways. The extra fluid is beneficial during reactions and daily baseline symptoms.

  • Third Spacing
Third spacing can be a symptom of Mast Cell Disease. It is characterized as the improper shift of fluid in the body, contributing to dehydration and angiodema. The body is unable to carry out normal function when oral fluids are displaced. IV hydration is proven to counteract third spacing.

  •   Low Blood Pressure
POTS is not the only condition that causes low blood pressure. Mast Cell Disease patients also have low blood pressure unrelated to postural changes. The low pressures are related to allergic reactions. Saline infusions temporarily increase the pressure, even if the fluid treatment is reserved for acute situations.

  • Dehydration
Mast Cell Disease patients tend to vomit and have diarrhea frequently. This inevitably leads to dehydration. Saline infusions replace what is lost. Electrolytes can be added to the fluids, which resolves imbalances.

"How is this different than drinking fluids orally/via feeding tube with Mast Cell Disease?"

  • Anaphylaxis / Reactions 
Many patients with POTS/Dysautonomia have a Mast Cell Disease. Mast Cell Diseases cause easily triggered, severe allergic reactions that can potentially lead to anaphylaxis. Triggers vary. In extreme cases, water is a trigger. That is obviously not ideal if needing to drink extra water to treat POTS/Dysautonomia. 

"How is water a trigger?"

The actual water is rarely the trigger of reactions, but secondary factors instead. 

First is temperature. Both cold and heat causes mast cells to degranulate. Ingesting water straight from the fridge is cold. In extremely sensitive individuals, even drinking water at room temperature is enough to induce symptoms. Warming the water to body temperature reduces the possibility of reactions to the water temperature. 

Next, excipients in the water is the most frequent cause of reactions. The vessels holding the water is a reaction risk. The plastics forming the bottles leech into the water, thus contaminating it with chemicals. In the normal, healthy population this is not a huge deal. The companies simply avoid the use of BPA and most feel comfortable purchasing the product, but there are plastics other than BPA that are harmful to people with chemicals sensitivities. Drinking water that was stored in glass rather than plastic offers less chance of contamination. 

However, purchasing the brands of water that come in glass, like VOSS, present another issue. The fancier waters have a variety of minerals added that are not confuse to those with a Mast Cell Disease. Such minerals and traces of chlorine and chemicals are found in some store bought brands and tap water. Distilling water through a filter removes the contaminants, decreasing reactions. 

Mast Cell Disease Reactions To IV Hydration Therapy

Replacing PO hydration with intravenous hydration does not remove the prospect of reactions. While it is supposed to help, sometimes receiving intravenous saline actually causes reactions. This is due to a number of reasons.

How can saline cause a reaction?

  • Rate
When mast cells are already triggered, shocking the body with bolus fluids can causes further degranulation. Reducing the rate that the saline is normally ran at ensures that an already compromised body is not overloaded.

The rate I usually infused my hydration is 200 mL/hr. In the case of a reactive day, I choose to run the saline on my backup pump set at 80 mL/hr.

  • Temperature
Just as water temperature can be a trigger when drinking it orally or administered via a feeding tube, it is important to keep intravenous saline at body temperature too. Prior to infusing, I use body heat to warm my fluid back if it is cold. I wrap it in a towel and "hug" the bag until desired temperature.

  • Excipients in the IV bag
The materials that make up the IV bags can leech into the intravenous fluids. Be cautious of the types of plastics in the supplies. Try to find bags without latex and DEHP.

  • Preservatives 
Not all intravenous saline is pure. Preservatives are added to prolong stability. A reactions to the "saline" might only be a sensitivity to inactive ingredients. 

Read Excipient Recipient: Mast Cell Reactions To Excipients to learn more about the added ingredients in medical supplies and medications that can provoke reactions.

The idea of beginning IV treatments is conceivably scary, but the positives are worth it. The therapy definitely makes life with POTS/Dysautonomia and Mast Cell Disease easier.

Don't forget to check out the IV Therapies For mast Cell Disease + Related Conditions Resource List!

Are you interested in IV therapy? Do you have a Mast Cell Disease? Join the Facebook group IV Therapies For Mast Cell Disease + Related Conditions