Is Regular IV Fluid Therapy Safe for Those with High Blood Pressure and POTS?
Age: 25, Weight: 230 lbs, Height: 5'9" Health Conditions: Postural Orthostatic Tachycardia Syndrome (POTS), Hypermobile Ehlers-Danlos Syndrome (hEDS), Mast Cell Activation Syndrome (MCAS), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), migraines, endometriosis, Polycystic Ovary Syndrome (PCOS), vitamin D deficiency. Current Medications: Zofran, Allegra, vitamin D, hydroxyzine, ibuprofen, and Mucinex Sinus PE during illness. Earlier this year, I received a diagnosis of POTS after living with symptoms that have persisted throughout my life and worsened significantly following multiple COVID infections. My ME/CFS contributes to severe post-exertional malaise, which has negatively impacted my weight—gaining has stemmed from my PCOS prior to the pandemic. This has limited my ability to engage in physical activity, something I dearly miss, leading me to actively pursue effective treatments. Living in a remote area complicates my search for healthcare experts familiar with my conditions, which often present overlapping symptoms, making the quest for specialized care a challenge. I previously consulted a specialist in dysautonomia who suggested saline infusions on a weekly basis, potentially ramping up to three times per week. However, due to recent increases in costs and lack of insurance collaboration, I've discontinued visits with her. A concern arises with my blood pressure; during a tilt table test, it alarmingly spiked to 200/170 before settling around 140/100 when I was lying flat. They administered IV metoprolol afterward, which partially alleviated the spike. My cardiologist prescribed this medication upon my inquiry but deemed it not critical. However, I have yet to start taking it due to recent surgery and ongoing illness, aiming to begin once I fully recover. My primary care physician is contemplating initiating IV fluid therapy, acknowledging that my fatigue, malaise, and presyncope tend to improve following fluid administration. Yet, I've encountered information suggesting that fluid therapy can be detrimental for individuals with elevated blood pressure. Recently, my blood pressure readings have remained concerningly high, reaching around 160/100 even while resting in bed. I would appreciate any insights or advice regarding this situation. What factors should I take into account?
Answers (1)

8/28/2025, 12:32:12 AM
OpenHealth AI
It's understandable that you have concerns about starting regular IV fluid therapy, especially with your complex health profile, including high blood pressure and POTS. Here’s a breakdown of the key considerations and what to focus on moving forward.
Key Points:
- IV Fluid Therapy and High Blood Pressure: IV fluids can help manage POTS symptoms, but their impact on blood pressure must be carefully evaluated.
- Monitoring and Management: Ongoing monitoring of your blood pressure is essential, especially when beginning any new treatment like IV fluids.
Explanation:
- Postural Orthostatic Tachycardia Syndrome (POTS) often leads to symptoms like fatigue and presyncope, which can sometimes improve with fluid therapy due to increased blood volume. However, since you also experience elevated blood pressure readings, this requires careful consideration.
- While hydration is essential for POTS management, excessive fluid can increase blood pressure, particularly in individuals with hypertension. It's crucial to balance the benefits of IV fluids for your POTS symptoms with the potential risks for your cardiovascular health.
Next Steps:
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Communicate with Your Healthcare Team: Discuss your blood pressure concerns explicitly with your primary care physician and ensure they are aware of your recent high readings (160/100). This dialogue is crucial for tailoring your treatment plan safely.
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Consider Blood Pressure Management: Prior to starting IV fluids, explore initiating metoprolol as prescribed by your cardiologist. This may help regulate your blood pressure, making IV fluid therapy safer.
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Start with Caution: If your doctor decides to proceed with IV fluid therapy, suggest starting with lower volumes and closely monitoring your blood pressure before and after administration to assess any negative impacts.
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Lifestyle Modifications: In the meantime, focus on lifestyle changes that might help manage both POTS and hypertension:
- Increase salt intake (under medical guidance), as it can help raise blood volume.
- Stay well-hydrated by drinking adequate fluids (consult your doctor for specific recommendations based on your condition).
- Engage in gentle, supervised exercises like supine leg lifts or stretching to enhance circulation without triggering symptoms.
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Keep a Symptom Journal: Track your blood pressure readings, weight fluctuations, and any changes in symptoms relative to changes in treatment or lifestyle. This information can be very helpful for your healthcare team.
Conclusion:
It's essential to move cautiously, liaising with your healthcare providers while implementing these strategies. Prioritize regular monitoring of your condition, and keep them informed of any changes. Remember, you're not alone in this, and ongoing communication with your healthcare team is key to finding a safe and effective treatment approach for your unique health needs.
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