POTS (Postural Orthostatic Tachycardia Syndrome) Protocol
Core Therapy: IV Fluids (Primary Intervention)
- Normal saline 500ml
- Magnesium Sulphate 500mg
- B-Complex Plus - 2ml (see breakdown in Quick Reference Guide)
** Please avoid NAD+ ** - can trigger tachycardia, anxiety)
Frequency Framework
Short-term stabilization model:
Week 1–2:
- 1–2 infusions weekly if severe
Week 3–4:
- Reassess symptom scale
Then:
- Taper
- Encourage oral fluids + salt loading
- Compression garments
- Graded exercise therapy
Long-term weekly IV fluids without review = poor clinical governance
Adverse Reactions
- Fluid overload
- Peripheral edema
- Hypertension
- Electrolyte imbalance
- Vasovagal reaction
- Increased anxiety if infused rapidly
Absolute Contraindications
- Heart failure
- Significant renal impairment
- Uncontrolled hypertension
- Structural cardiac disease
- Severe electrolyte imbalance
- Pregnancy (relative — assess individually)
Further treatment:
Oral salt loading (8–10g/day where appropriate) - please use celtic salt
- 2–3L daily fluid intake
- Compression therapy
- Structured exercise rehabilitation
Many POTS patients have:
- Low circulating blood volume
- Poor vascular tone
- Blood pooling in lower limbs
Increasing salt:
- Helps the body retain water
- Expands plasma volume
- Reduces tachycardia on standing
- Improves dizziness
Salt Must Be Combined With Fluids
Salt loading without fluid intake will not work.
Typical recommendation in POTS care:
2–3 litres of fluids daily PLUS increased salt intake
What Does 8–10 g of Salt Look Like?
Approximate examples:
1 level teaspoon salt ≈ 5–6 g
So 8–10 g ≈ 1.5–2 teaspoons per day (spread out)
This can be achieved through:
- Salted food
- Electrolyte powders
- Salt capsules
- Oral rehydration solutions
Who Should NOT Salt Load?
Avoid or use caution in:
- Hypertension
- Kidney disease
- Heart failure
- Pregnancy-related hypertension
- Certain cardiac conditions
Always under medical guidance.