Hydration And Sodium

● Background/Indications: Adults typically require between 2000 and 3000 milligrams (mg) of sodium daily for good health. While low-salt diets have been recommended for preventing heart disease and stroke, people with orthostatic intolerance, such as those with neurally mediated hypotension or postural tachycardia syndrome (POTS), often cannot tolerate such low sodium intake. These individuals may need significantly higher sodium levels. However, the long-term effects of increased sodium intake on blood pressure in POTS are still unknown.

● Contraindications: hypertension. Those on diuretic medications like furosemide (Lasix)

● Mechanism of Action: Increased vascular volume to improve blood pressure.

● Side Effects: Determining the ideal salt concentration for each individual is challenging. The required amount of sodium varies from person to person, often influenced by their preference for salty foods. While it is generally hard to consume too much sodium, as long as plenty of fluids are available to manage thirst, some individuals may experience side effects like weight gain, edema (swelling) in the extremities, headaches, or agitation when increasing sodium intake.

● Expected Benefits: Reduces tachycardia, palpitations, syncope, and fatigue. It can help patients manage heart rate during exercise, enabling greater physical activity.

● Dosage: A daily intake of 8 to 12 grams (range from 2g-12g depending on source) of sodium chloride along with 2-3 liters of fluid, is recommended for managing the condition. Sodium sources include table salt (2300 mg of sodium per teaspoon), salt tablets or supplementation additives (i.e. LMNT, Vitassium, Buoy, or better reported tolerance of buffered salt tablets like Thermotabs), sports drinks, rehydration salts, and soups.

● IV Hydration: Intravenous boluses of 1 to 2 liters of normal saline can be used for hypovolemic patients who cannot tolerate increased oral fluid intake, providing relief from orthostatic symptoms for up to two days. This approach can serve as a short-term solution to help patients engage in physical exercise and other lifestyle changes. However, long-term use of intravenous saline infusions via a central venous port does come with its risks (venous thrombosis, bacteremia, and systemic infections) and should be discussed with doctor based on individual case.

Citations

Conner, R., Sheikh, M., & Grubb, B. (2012). Postural orthostatic tachycardia syndrome (POTS). BJMP, 5(4), a540. Retrieved from https://www.bjmp.org/files/2012-5-4/bjmp-2012-5-4-a540.pdf

Garland, E. M., Gamboa, A., Nwazue, V. C., Celedonio, J. E., Paranjape, S. Y., Black, B. K., Okamoto, L. E., Shibao, C. A., Biaggioni, I., Robertson, D., Diedrich, A., Dupont, W. D., & Raj, S. R. (2021). Effect of high dietary sodium intake in patients with postural tachycardia syndrome. Journal of the American College of Cardiology, 77(17), 2174–2184. https://doi.org/10.1016/j.jacc.2021.03.005

Ruzieh, M., Baugh, A., Dasa, O., Parker, R. L., Perrault, J. T., Renno, A., Karabin, B. L., & Grubb, B.

Harris, C. I. (2022). COVID-19 increases the prevalence of postural orthostatic tachycardia syndrome: What nutrition and dietetics practitioners need to know. Journal of the Academy of Nutrition and Dietetics, 122(9), 1600-1605. https://doi.org/10.1016/j.jand.2022.06.002

Low, P. A., Sandroni, P., Joyner, M., & Shen, W. K. (2009). Postural tachycardia syndrome (POTS). Journal of Cardiovascular Electrophysiology, 20(3), 352-358. https://doi.org/10.1111/j.1540- 8167.2008.01407.x

Mar, P. L., & Raj, S. R. (2020). Postural orthostatic tachycardia syndrome: Mechanisms and new therapies. Annual Review of Medicine, 71, 235-248. https://doi.org/10.1146/annurev-med-041818-011630

Miller, A. J., & Raj, S. R. (2018). Pharmacotherapy for postural tachycardia syndrome. Autonomic Neuroscience, 215, 28-36. https://doi.org/10.1016/j.autneu.2018.04.008

Stock, J. M., Chelimsky, G., Edwards, D. G., & Farquhar, W. B. (2022). Dietary sodium and health: How much is too much for those with orthostatic disorders?. Autonomic Neuroscience: Basic & Clinical, 238, 102947. https://doi.org/10.1016/j.autneu.2022.102947