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

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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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Authors and Affiliations

  1. Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA

    Jeffrey P. Moak, Derek Leong, Robin Fabian, Vicki Freedenberg, Elizabeth Jarosz, Carol Toney & Sridhar Hanumanthaiah

  2. Division of Gastroenterology, Children’s National Medical Center, Washington, DC, USA

    Anil Darbari

Authors
  1. Jeffrey P. Moak
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  2. Derek Leong
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  3. Robin Fabian
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  4. Vicki Freedenberg
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  5. Elizabeth Jarosz
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  6. Carol Toney
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  7. Sridhar Hanumanthaiah
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  8. Anil Darbari
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Correspondence to Jeffrey P. Moak.

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Moak, J.P., Leong, D., Fabian, R. et al. Intravenous Hydration for Management of Medication-Resistant Orthostatic Intolerance in the Adolescent and Young Adult. Pediatr Cardiol 37, 278–282 (2016). https://doi.org/10.1007/s00246-015-1274-6

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  • DOI: https://doi.org/10.1007/s00246-015-1274-6

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