increases plasma volume, reduces heart rate and brain fog while bypassing the GI tract
There is currently no consensus in the medical community on the utility of intravenous (IV) saline in people with postural orthostatic tachycardia syndrome (POTS). Some physicians will prescribe it for acute hypovolemic shock (discussed below), but not for regular long term care, for a variety of reasons. Other physicians will prescribe daily or weekly use of IV saline in treatment of POTS in some patients. Some use IV saline 24/7 using a battery operated pump in a backpack. Many people with POTS will use a PICC line or port a couple of times a week for a liter or two of saline.
Intravenous saline is used to treat significantly low blood volume, which can be a problem for some people with POTS. This can be difficult for doctors to test because it is a ratio of red blood cells to plasma volume. In POTS, both the number of red blood cells and the plasma volume can be low (and thus the ratio appears normal on the CBC). For some with POTS, their blood levels can drop low enough to result in hypovolemic shock. The best way to get a measure of your blood volume is to do specific blood volume testing which uses a radioactive tracer called iodinated-RISA. The tracer is injected using an IV and then blood samples are taken over time to measure the tracer levels in your blood and determine your blood volume.
Symptoms of hypovolemic shock:
Be sure that you speak with your doctor about methods to increase and/or maintain your blood volume. There are several ways to increase your blood volume naturally, and these should be explored before considering IV saline as a therapy for low blood volume. The most common treatments used by people with POTS are increasing salt and water consumption. Exercise is also a great way to increase blood volume. There are also medications that can help with blood volume expansion (e.g., Florinef, midodrine).
Why might IV saline be better than oral fluids? In some cases, nausea and vomiting when drinking liquids defeats the purpose and can severely limit fluid intake. In others with rapid gut motility, less water is absorbed into the body than normal as it is rushed through the intestines. In addition, if your blood volume is low, but the ratio between red blood cells and plasma is normal, you may not be able to absorb the fluids even if you are drinking several liters per day.
Why use IV fluids? Intravenous fluids bypass the digestive tract to eliminate issues with nausea/vomiting and gut motility. The saline goes directly into your bloodstream to increase the plasma volume. In fact, a liter of normal saline can reduce both heart rate and other symptoms like brain fog in a person with POTS if her blood volume is low.
The main barrier in using IV fluid therapy is accessing the bloodstream. When a person has low blood volume, their veins tend to be small and difficult to access. The decision to use regular IVs, PICC lines, and ports must be made with your doctor and depends on a number of factors.
These are the traditional IVs that are accessed via veins in the arm, hand, neck, or feet. They stay in the periphery and never approach the superior vena cava or the heart. The tube that fits into your vein is generally less than two inches long and can be placed by most nurses. These work well for those with good veins who need infrequent access (once a week or less) to IV fluids. Regular IVs are inexpensive and can be easily placed and removed. The downside to regular IVs is that you must go to the ER, doctor’s office, or an infusion center to get IV saline.
If you need to go to the Emergency Department for IV saline, consider printing this sample letter and discussing it with your doctor. If your doctor will modify this and put it on letterhead, you could carry it with you when you have to visit the ER for IV fluids.
All of these devices will be placed into the superior vena cava, a large vein that leads into the right atrium of your heart. Both implantable ports and peripherally inserted central catheters (PICC) are central access devices. Consider talking with your doctor about a PICC line or a port if you have been getting infusions more than once a week for at least 6 months.
Central access devices can be used to give long term medicine treatment for pain, infection, or cancer. They can also be used to deliver nutrition or large amounts of blood or fluid quickly. In addition, these devices can allow frequent blood samples without having an additional “stick.” In most people with POTS, these lines are used mainly for administration of saline therapy.
These devices can be accessed by professionals at an infusion center or by you and your family at home. For many people with POTS, the ability to get IV fluids at home when starting to go into hypovolemic shock can improve overall quality of life and help make life more predictable by stopping flares quickly.
The following groups would be advised NOT to use a port:
For free, full-length scientific articles on IV saline and POTS, visit Scientific Articles on IV Saline and POTS
For a more personal view of POTS and IV saline options, click here.