Oral Rehydration Salts: An Effective Choice for the Treatment of Children with Vasovagal Syncope

Abstract

To explore whether oral rehydration salts (ORS) is effective in the treatment of children with vasovagal syncope (VVS). One hundred and sixty-six consecutive patients with recurrent syncope and positive head-up tilt testing (HUTT) were recruited, randomly divided to conventional therapy (health education and tilt training) plus ORS (with 500 ml of water) group (Group I, 87 patients) and conventional therapy group (Group II, 79 patients). Therapeutic effect was evaluated by changes of syncopal episode and reperformed HUTT response. At the end of 6-month follow-up, syncopal episode did not reoccur in 49 (56.3 %) patients, decreased in 34 (39.1 %) patients, and had no obvious change or increased in four (4.6 %) patients in Group I, and the results were 31 (39.2 %), 37 (46.8 %), and 11 (14 %) in Group II, respectively. The difference was significant (χ (2) = 7.074, P < 0.05). When HUTT was reperformed, 57 (65.5 %) and 28 (35.4 %) patients had negative response and 30 (34.5 %) and 51 (64.6 %) patients had positive response, respectively, in Group I and Group II. The difference was also significant (χ (2) = 13.808, P < 0.01). In Group I, the two aspects had no difference between vasodepressor type and mixed type; however, syncopal episode had a significant difference between children aged ≤12 and >12 years (χ (2) = 6.371, P < 0.05); there was no difference in reperformed HUTT response. ORS with 500 ml of water is an effective therapy for VVS. It can be recommended as one of non- pharmacological treatment measures in children with VVS.

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

“…Management of children with V VS should include reassurance about the generally benign nature of this condition. 641,642 Treatment should emphasize symptom awareness and avoidance of precipitating factors that might worsen the condition, such as dehydration, standing for prolonged periods of time, hot crowded environments, and diuretic intake. 624,629,643,644,647,648,651,652 and the specificity ranges from 83% to 100%.…”

“…IIb B-R Encouraging increased salt and fluid intake may be reasonable in selected pediatric patients with V VS. 642 See Online Data Supplement 40.…”

Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient

“…In a randomized trial of 166 children and adolescents oral rehydration salts (a mixture of NaCl, KCl, and NaHCO 3 ) decreased syncope recurrences for up to 6 months (56% vs 39%; P ¼ 0.029). 27 Both groups also received education and tilt training consisting of periods of standing upright. In adults, physical techniques like squatting, crossing legs, or buttocks-clenching while upright prevented syncope in randomized open-label trials.…”

Reduced 24-h Sodium Excretion Is Associated With a Disturbed Plasma Acylcarnitine Profile in Vasovagal Syncope Children: A Pilot Study

“…Low sodium intake is one proposed mechanism of VVS and leads to hypovolemia and alterations in biologically active substances which are likely to contribute to syncopal occurrence, including renin, aldosterone, and catecholamine (10)(11)(12). As a result, supplementation of fluid and sodium is a rationally efficient method to treat VVS (13). A possible relationship between the metabolism of carnitine and acylcarnitines and the reducing intake of sodium was mentioned among adults with hypertension (14).…”