Orthostatic Cognitive Dysfunction in Postural Tachycardia Syndrome After Rapid Water Drinking, 2019, Belén Rodriguez et al

Abstract
Background: Postural tachycardia syndrome (POTS) is a form of autonomic dysregulation and is characterized by an excessive heart rate (HR) increment upon the upright body position while blood pressure is maintained. Patients experience typical symptoms of orthostatic intolerance such as dizziness, nausea and cognitive impairments. The present study assessed position-dependent attentional and cognitive functioning in POTS patients compared to healthy subjects and tested the response of cognitive performance to acute water intake. Methods: Data was obtained from eight patients with neuropathic POTS and eight healthy subjects of similar age and gender. All participants completed questionnaires that assessed health-related quality of life and depression and underwent four rounds of neuropsychological testing overall, each before and after the intake of 500 ml still mineral water and both in the supine and in the upright posture. Results: Postural tachycardia syndrome patients showed deficits in working memory (WM) exclusively in the upright position compared to healthy subjects, but no position-dependent impairments in alertness or divided attention. Rapid water ingestion had a beneficial effect on WM in the upright posture, lead to a decrease in HR increment and to an improvement of subjective symptom experience. Conclusion: The results provide support for the occurrence of purely orthostatic cognitive deficits in POTS, especially when increased executive control and cognitive resources are required and document a favorable effect of water intake on cognitive performance. These findings have important implications for the management of cognitive symptoms in POTS as high water intake is an easy and accessible strategy.

https://pubmed.ncbi.nlm.nih.gov/31024242/

 

As long as you don't mind peeing 27 times per day and several times at night. Which I do.

 

did not read paper but a caution:

- ime i think rapid water drinking, at least of cold water, can trigger a gastroparesis attack [6 gulps]
- ime i think gastroparesis can take a long time to diagnose

please note that:

- idk what type of severe oi i have
- my sample size is too small to draw strong conclusions

 

Do you sweat?

 

Yes but not excessively. At least not usually. As long as I keep my temperature in check, though, I can go from cold to blistering hot in seconds but otherwise seem to sweat as usual.

 

Exactly what I thought of right away. Output after lots of fluid is quite something!

 

@Mij

Can you expand on your comment about sweating?

I note the subjects drank mineral water. Not totally sure what they mean by "mineral water". Water with minerals added in, or just sparkling water?

Probably they just used sparkling (mineral) water.

Some advise to use minerals to help with ME, or electrolyte drinks. I don't think this is what the researchers meant....

Extra hydration has been a go to for many years for pwME to help with POTS. It has its up and downsides, as @rvallee and I have pointed out.

 

I've read that abnormalities of sweating is not uncommon for people with dysautonomia. When I'm in PEM I feel hot/dehydrated but I'm unable to sweat.

I was thinking that frequent urination might indicate low level of electrolytes or similar symptoms to diabetes insipidus where extreme thirst can't be quenched and frequent urination occurs (polyuria).

I don't urinate much when I drink liters of homemade chicken broth with added sea veggies and sea salt. I can sit and stand upright for longer periods of time and I have a general sense of well being after I drink salty broth

Yeah, who knows. I read somewhere that a 'true' mineral water has to contain a certain % of magnesium in order to be labeled as such.

 

This is very interesting. I make myself an electrolyte drink, which I think helps me. Though I don’t drink it daily, nor even remember to drink it at appropriate moments. (Must do better )

So, I wonder what time interval is ideal? Presumably time enough to be absorbed into the blood stream, but not sufficient time to have had the kidneys remove it again!

It’s likely this, coupled with compression, are very helpful tactics for specific endeavours.

Mind you I wee often enough as it is!!!! LOL

 

Speaking of compression, my OI doesn't kick in when I'm in a pool. Not swimming, as that would put me into PEM, but just noodling around is OK. I don't feel lightheaded while upright in the water.

 

noodling around sounds like fun . a new saying for me .

 

My heart rate went up when I was in a heated pool 'noodling around'. It took me 2 days to recover.

 

Not good, @Mij . Maybe it depended on the temperature? Although pools aren't going to be hot. A hot bath or shower, will make me feel weak and ill in a few minutes.

Other than being supine, a pool is the only place I have noted any relief from OI, or the potential that OI will kick in.

 

@DokaGirl

We have a heated pool in my building, and early on in my illness I used to go down and walk around in the low end or sit by the jets to help increase circulation. The pool was comfortably heated, not hot, but I felt so weak after I could barely walk, and this was during the time I wasn't as disabled as I am now.

 

I understand. Weakness.

ETA: I have no idea, but maybe the balance of warm water and being in an outdoor pool helped in my case. Who knows.

We do know pwME are temperature sensitive. I can get overheated very quickly, and feel ill, heart pounding etc. I have to very soon get cooled off, or I continue to feel worse. This makes for throwing the bed covers off and on several times/night.

ETA#2: Added the word "know".