Clinical Outcomes Following Intravenous Saline Infusion in Adolescents With Refractory Postural Orthostatic Tachycardia Syndrome: A Retrospective Study

BackgroundPostural orthostatic tachycardia syndrome (POTS) can substantially impair daily functioning and school attendance in adolescents.Evidence regarding intravenous (IV) saline infusion in adolescents with refractory POTS remains limited.This study evaluated short-term clinical outcomes and adverse events following IV saline infusion administered during symptom exacerbations in adolescents with refractory POTS. MethodsThis retrospective, single-center study identified 53 adolescents with refractory POTS between April 2021 and March 2022.Of these, 42 received peripheral IV saline infusion, while 11 did not.The primary outcome was subjective treatment response assessed within one month after treatment initiation in all 42 treated patients.Paired assessments of orthostatic dysregulation (OD) physical symptom scores, school attendance and daily functioning scores, and standing heart rate were available for 22 patients at baseline and approximately one month after treatment initiation.Paired symptom and functional outcomes were compared using two-sided Wilcoxon signed-rank tests.Documented adverse events were also reviewed. ResultsThirty-six of 42 patients (85.7%) reported at least some subjective improvement.The 22 patients with paired one-month assessments received a total of 66 infusions, with a mean of 3.0 infusions per patient.Among these patients, the mean OD physical symptom score decreased from 7.5 ± 1.5 to 6.1 ± 2.0 (P = 0.004), and the mean school attendance and daily functioning score decreased from 2.5 ± 1.4 to 1.7 ± 1.6 (P = 0.023).The proportion of patients with some school participation increased from 54.5% to 77.3%, although the difference was not statistically significant (P = 0.125).Among 20 patients who completed paired standing tests, the mean maximum heart rate increase decreased from 41.7 to 38.2 beats/min, without statistical significance (P = 0.254).Transient adverse events included pain during needle insertion and feeling cold during infusion.No venous-access infection or thrombosis was documented among the 22 patients with available short-term follow-up assessments. ConclusionsIn adolescents with refractory POTS, IV saline infusion administered during symptom exacerbations was followed by subjective improvement in most patients and lower physical symptom and daily functioning scores among those with paired one-month assessments.Changes in school attendance status and standing heart rate were not statistically significant.These findings suggest that IV saline may have a role in shortterm symptom relief during acute exacerbations, although its efficacy cannot be established from this uncontrolled study.Long-term safety remains uncertain, and prospective controlled studies are needed to clarify the benefits, risks, and appropriate use of this approach.