The value of Intravenous saline infusions for acute control of heart rate symptoms in POTS patients was demonstrated in a 1990’s article by Dr. Biaggioni and colleagues entitled
Effects of Volume Loading and Pressor Agents in Idiopathic Orthostatic Tachycardia
Giris Jacob, John R. Shannon, Bonnie Black, Italo Biaggioni, Rogelio Mosqueda-Garcia, Rose Marie Robertson and David Robertson
In this article they demonstrate the superior effect on heart rate of 1L Normal Saline infused rapidly over one hour compared to midodrine and clonidine.
The table below comes from the article and graphically demonstrates the value of IV Saline.
The decrease in heart rate after the saline is dramatic compared to placebo, midodrine and
clonidine (solid black bar on the right of each figure). There was no reported complications
or side effects noted in the Saline group, thus making this a safe and inexpensive
way to deal with POTS patients who are suffering from volume depletion and significant
debilitating postural tachycardia. Physicians should be aware of this method and utilize it as part of their
armamentarium for combatting POTS.
The effects of the saline infusion will typically last hours to days to even longer based on the
unique characteristics of each individual patient. Giving it rapidly and in a low stress
environment such as the doctor’s office, local urgent care center or even at home with home infusion service
will maximize the benefit and often result in a significant performance benefit that can enable the patient to fulfill their role in society and often allow for the discontinuation of various more toxic medications or other treatments.