title: Intravenous Hydration for Management of Medication-Resistant Orthostatic Intolerance in the Adolescent and Young Adult.
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.
authors.affiliation: Division of Cardiology, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA. jmoak@childrensnational.org.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Moak
authors.affiliation: Division of Cardiology, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Leong
authors.affiliation: Division of Cardiology, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Fabian
authors.affiliation: Division of Cardiology, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Freedenberg
authors.affiliation: Division of Cardiology, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jarosz
authors.affiliation: Division of Cardiology, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Toney
authors.affiliation: Division of Cardiology, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
authors.forename: Sridhar
authors.initials: S
authors.lastname: Hanumanthaiah
authors.affiliation: Division of Gastroenterology, Children's National Medical Center, Washington, DC, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Darbari
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D019468:Disease Management; D005081:Exercise Therapy; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D054971:Orthostatic Intolerance / Q000150:complications* / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D057566:Self Report; D012965:Sodium Chloride / Q000008:administration & dosage*; D018667:Tilt-Table Test; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D012965:Sodium Chloride
keywords: Children; Intravenous hydration; Orthostatic intolerance; Postural Orthostatic Tachycardia Syndrome; Quality of life