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Cited by 34Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlLong-Term Effects of COVID-19

Intravenous Hydration for Management of Medication-Resistant Orthostatic Intolerance in the Adolescent and Young Adult

Moak, Jeffrey P., Leong, Derek, Fabian, Robin, Freedenberg, Vicki, Jarosz, Elizabeth, Toney, Carol, Hanumanthaiah, Sridhar, Darbari, Anil·2016·Pediatric Cardiology
DOI 10.1007/s00246-015-1274-6
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Abstract

Orthostatic intolerance (OI) is common in teenagers (T) and young adults (A). Despite treatment with oral fluids, medication, and exercise, a significant number have symptoms from multiple organ systems and suffer low quality of life (QOL). Previous studies showed that acute intravenous (IV) hydration (IH) could help restore orthostatic tolerance; however, no data are available about the intermediate-term effects of IH. We therefore studied the efficacy of IH to improve QOL and manage medication-refractory OI patients. Our study population consisted of 39 patients (mean age = 16.1 ± 3.3) years; thirty-two were female. Average number of medications failed = 3.1. Average QOL score on self-reported OI questionnaire was 4.2 (normal QOL = 10). IV hydration consisted of normal saline (1-2 l/day, 3-7 days/week). 1) Orthostatic testing revealed Postural Orthostatic Tachycardia (24), Neurally Mediated Hypotension (14) or OI (1). 2) Average orthostatic change in heart rate was 48 ± 18 bpm. 3) IH was performed via intermittent IV access (10), PICC line (22), and Port (7). 4) Duration of IH varied from 1 week to 3.8 years (mean = 29 ± 47 weeks). 5) Overall, 79 % (n = 31) demonstrated clinically improved self-reported QOL. 6) Six patients who discontinued IH requested to restart treatment. (7) Complications consisted of upper extremity deep vein thrombosis (n = 3) and infection (n = 4). IH is an effective therapy to improve QOL in T&A with medication-resistant OI. Most patients continued to report improved QOL once IH was discontinued. IH should be considered a therapeutic option in medication-resistant OI patients with low QOL.

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Crossref · 10.1007/s00246-015-1274-6

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  • Acute infusions of normal saline are not sustainable in the long term due to the potential for vascular access complications.

    “but this approach is not sustainable in the long-term due to the potential for vascular access complications (67).”

    From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [67]

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Authors
Moak, J. P., Leong, D., Fabian, R., Freedenberg, V., Jarosz, E., Toney, C., Hanumanthaiah, S., & Darbari, A.
Affiliations
Children's National (US)
Corresponding author
Moak, Jeffrey P.
ORCID
Venue
Pediatric Cardiology
Publisher
Springer Science and Business Media LLC
Published
2015-10-07
Volume
37
Issue
2
Pages
278-282
ISSN
  • 0172-0643 (ISSN-L)
  • 1432-1971
DOI
10.1007/s00246-015-1274-6
OpenAlex
W1954547554
Cited by
34
References
32
Citations by year
2026: 3 · 2025: 2 · 2024: 4 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 2
FWCI
3.70
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Pediatric Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
Keywords
orthostatic intolerance, intravenous hydration, adolescents and young adults, quality of life, postural orthostatic tachycardia syndrome, normal saline infusion, deep vein thrombosis, long-term treatment outcomes
MeSH terms
Adolescent, Blood Pressure, Child, Exercise Therapy, Female, Fluid Therapy, Heart Rate, Humans, Injections, Intravenous, Male, Quality of Life, Retrospective Studies, Sodium Chloride, Treatment Failure, Tilt-Table Test, Disease Management, Orthostatic Intolerance, Young Adult, Self Report

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