Fludrocortisone improves nausea in children with orthostatic intolerance (OI)

Abstract

Association of EGG abnormalities and OI in this subset of nausea patients suggests a generalized disturbance of autonomic regulation.

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

“…As we have previously reported (12,13), pediatric subjects presenting with various OI symptoms frequently demonstrated an abnormal HUT, raising the possibility of a cardiovascular basis for their OI, including gastrointestinal symptoms. The majority (62.5%) of patients with reported orthostatic dizziness were HUT(ϩ), consistent with findings in adults (36) patients experienced syncope later in the HUT (10).…”

“…Increases in AVP and Epi during HUT have also been observed in both adult OH and vasovagal syncope subjects (23,32,37). OI is also observed in pediatric patients (12) but is particularly difficult to diagnose and treat as it is underrecognized, and testing, such as HUT, can be invasive for children. Characterization of the neurohumoral response to orthostatic challenge in children with OI has not been well described, but dysregulation of these systems likely plays a role in its pathogenesis (12,13).…”

The gastrointestinal symptoms present in patients with postural tachycardia syndrome: A review of the literature and overview of treatment

“…The possible causes of this were discussed earlier in this chapter. As described earlier, nausea replicated during HUT (therefore secondary to an orthostatic challenge) often improves with volume expansion with fludrocortisone (Fortunato et al, 2011;Sullivan et al, 2005).…”

“…A few elegant studies have shown the relationship of the orthostatic challenge and gastrointestinal symptoms. The gastrointestinal symptoms that often occur during HUT include nausea and abdominal pain (Fortunato et al, 2011;Fortunato et al, 2014;Sullivan et al, 2005). Moak et al performed 24-h antroduodenal manometry studies in pediatric patients with OI and GI symptoms and tilted the subjects during the antroduodenal motility study.…”

“…Furthermore, the head up tilt (HUT) induced abnormalities in antroduodenal motility in 68% of the subjects, with neurogenic intestinal dysmotility, antral hypomotility, visceral hyperalgesia, and regurgitation or a combination of these findings (Moak et al, 2016). Sullivan et al (2005) and later Fortunato et al (2011) documented that nausea replicated during HUT often improves with volume expansion with fludrocortisone. Other symptoms and complaints which also improved with this treatment, including dizziness, abdominal pain, flushing, and missing school (Fortunato et al, 2014).…”