Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome

Andrew S. Tseng, Nicole A. Traub, Lucinda A. Harris, Michael D. Crowell, Charlene R. Hoffman-Snyder, Brent P. Goodman, John D DiBaise

Research output: Contribution to journalArticle

Abstract

Background: Patients with postural tachycardia syndrome (POTS) often have gastrointestinal (GI) symptoms. Occasionally, these symptoms can be so severe that nonoral nutrition/hydration support (NONHS), including intravenous fluids (IVFs), enteral nutrition (EN), and parenteral nutrition (PN), becomes necessary. Methods: This is a retrospective cohort study of adult patients diagnosed with POTS at the Mayo Clinic Arizona from January 2010 to January 2017 with a minimum of 6 months of follow up. Demographic information, symptomatology, medications, GI testing, autonomic and autoantibody testing, and healthcare utilization data were abstracted from the electronic medical record. Results: Three-hundred thirty-two patients with POTS were included, of which 32 required NONHS. Patients receiving NONHS were more likely to be female; have lower body mass index; have GI symptoms including nausea, vomiting, diarrhea, and constipation; have abdominal pain; use opiates; have delayed gastric emptying; see more specialists; and be seen in an emergency room or be hospitalized for symptoms. Of these patients, 21 (66%) required IVF, 19 (59%) required EN, and 9 (28%) required PN. Six (19%) patients required all 3 NONHS modalities at some point during their follow-up period. Conclusions: NONHS may be required in a subset of patients with POTS. Those receiving NONHS have more severe symptoms and abnormal GI motility and autonomic testing and exhibit greater healthcare utilization. Management of these patients is complex and challenging and requires a multidisciplinary approach. Further prospective studies are needed to identify optimal management strategies.

Original languageEnglish (US)
Pages (from-to)734-741
Number of pages8
JournalJournal of Parenteral and Enteral Nutrition
Volume43
Issue number6
DOIs
StatePublished - Jan 1 2019

Fingerprint

Postural Orthostatic Tachycardia Syndrome
Parenteral Nutrition
Enteral Nutrition
Opiate Alkaloids
Delivery of Health Care
Gastrointestinal Motility
Electronic Health Records
Gastric Emptying
Constipation
Autoantibodies
Nausea
Abdominal Pain
Vomiting
Hospital Emergency Service
Diarrhea
Body Mass Index
Cohort Studies
Retrospective Studies
Demography
Prospective Studies

Keywords

  • dysautonomia
  • gastrointestinal
  • nutrition
  • postural tachycardia syndrome

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Tseng, A. S., Traub, N. A., Harris, L. A., Crowell, M. D., Hoffman-Snyder, C. R., Goodman, B. P., & DiBaise, J. D. (2019). Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome. Journal of Parenteral and Enteral Nutrition, 43(6), 734-741. https://doi.org/10.1002/jpen.1493

Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome. / Tseng, Andrew S.; Traub, Nicole A.; Harris, Lucinda A.; Crowell, Michael D.; Hoffman-Snyder, Charlene R.; Goodman, Brent P.; DiBaise, John D.

In: Journal of Parenteral and Enteral Nutrition, Vol. 43, No. 6, 01.01.2019, p. 734-741.

Research output: Contribution to journalArticle

Tseng, AS, Traub, NA, Harris, LA, Crowell, MD, Hoffman-Snyder, CR, Goodman, BP & DiBaise, JD 2019, 'Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome', Journal of Parenteral and Enteral Nutrition, vol. 43, no. 6, pp. 734-741. https://doi.org/10.1002/jpen.1493
Tseng, Andrew S. ; Traub, Nicole A. ; Harris, Lucinda A. ; Crowell, Michael D. ; Hoffman-Snyder, Charlene R. ; Goodman, Brent P. ; DiBaise, John D. / Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome. In: Journal of Parenteral and Enteral Nutrition. 2019 ; Vol. 43, No. 6. pp. 734-741.
@article{125f523af5134fda9f26f4a280f655df,
title = "Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome",
abstract = "Background: Patients with postural tachycardia syndrome (POTS) often have gastrointestinal (GI) symptoms. Occasionally, these symptoms can be so severe that nonoral nutrition/hydration support (NONHS), including intravenous fluids (IVFs), enteral nutrition (EN), and parenteral nutrition (PN), becomes necessary. Methods: This is a retrospective cohort study of adult patients diagnosed with POTS at the Mayo Clinic Arizona from January 2010 to January 2017 with a minimum of 6 months of follow up. Demographic information, symptomatology, medications, GI testing, autonomic and autoantibody testing, and healthcare utilization data were abstracted from the electronic medical record. Results: Three-hundred thirty-two patients with POTS were included, of which 32 required NONHS. Patients receiving NONHS were more likely to be female; have lower body mass index; have GI symptoms including nausea, vomiting, diarrhea, and constipation; have abdominal pain; use opiates; have delayed gastric emptying; see more specialists; and be seen in an emergency room or be hospitalized for symptoms. Of these patients, 21 (66{\%}) required IVF, 19 (59{\%}) required EN, and 9 (28{\%}) required PN. Six (19{\%}) patients required all 3 NONHS modalities at some point during their follow-up period. Conclusions: NONHS may be required in a subset of patients with POTS. Those receiving NONHS have more severe symptoms and abnormal GI motility and autonomic testing and exhibit greater healthcare utilization. Management of these patients is complex and challenging and requires a multidisciplinary approach. Further prospective studies are needed to identify optimal management strategies.",
keywords = "dysautonomia, gastrointestinal, nutrition, postural tachycardia syndrome",
author = "Tseng, {Andrew S.} and Traub, {Nicole A.} and Harris, {Lucinda A.} and Crowell, {Michael D.} and Hoffman-Snyder, {Charlene R.} and Goodman, {Brent P.} and DiBaise, {John D}",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/jpen.1493",
language = "English (US)",
volume = "43",
pages = "734--741",
journal = "Journal of Parenteral and Enteral Nutrition",
issn = "0148-6071",
publisher = "SAGE Publications Inc.",
number = "6",

}

TY - JOUR

T1 - Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome

AU - Tseng, Andrew S.

AU - Traub, Nicole A.

AU - Harris, Lucinda A.

AU - Crowell, Michael D.

AU - Hoffman-Snyder, Charlene R.

AU - Goodman, Brent P.

AU - DiBaise, John D

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Patients with postural tachycardia syndrome (POTS) often have gastrointestinal (GI) symptoms. Occasionally, these symptoms can be so severe that nonoral nutrition/hydration support (NONHS), including intravenous fluids (IVFs), enteral nutrition (EN), and parenteral nutrition (PN), becomes necessary. Methods: This is a retrospective cohort study of adult patients diagnosed with POTS at the Mayo Clinic Arizona from January 2010 to January 2017 with a minimum of 6 months of follow up. Demographic information, symptomatology, medications, GI testing, autonomic and autoantibody testing, and healthcare utilization data were abstracted from the electronic medical record. Results: Three-hundred thirty-two patients with POTS were included, of which 32 required NONHS. Patients receiving NONHS were more likely to be female; have lower body mass index; have GI symptoms including nausea, vomiting, diarrhea, and constipation; have abdominal pain; use opiates; have delayed gastric emptying; see more specialists; and be seen in an emergency room or be hospitalized for symptoms. Of these patients, 21 (66%) required IVF, 19 (59%) required EN, and 9 (28%) required PN. Six (19%) patients required all 3 NONHS modalities at some point during their follow-up period. Conclusions: NONHS may be required in a subset of patients with POTS. Those receiving NONHS have more severe symptoms and abnormal GI motility and autonomic testing and exhibit greater healthcare utilization. Management of these patients is complex and challenging and requires a multidisciplinary approach. Further prospective studies are needed to identify optimal management strategies.

AB - Background: Patients with postural tachycardia syndrome (POTS) often have gastrointestinal (GI) symptoms. Occasionally, these symptoms can be so severe that nonoral nutrition/hydration support (NONHS), including intravenous fluids (IVFs), enteral nutrition (EN), and parenteral nutrition (PN), becomes necessary. Methods: This is a retrospective cohort study of adult patients diagnosed with POTS at the Mayo Clinic Arizona from January 2010 to January 2017 with a minimum of 6 months of follow up. Demographic information, symptomatology, medications, GI testing, autonomic and autoantibody testing, and healthcare utilization data were abstracted from the electronic medical record. Results: Three-hundred thirty-two patients with POTS were included, of which 32 required NONHS. Patients receiving NONHS were more likely to be female; have lower body mass index; have GI symptoms including nausea, vomiting, diarrhea, and constipation; have abdominal pain; use opiates; have delayed gastric emptying; see more specialists; and be seen in an emergency room or be hospitalized for symptoms. Of these patients, 21 (66%) required IVF, 19 (59%) required EN, and 9 (28%) required PN. Six (19%) patients required all 3 NONHS modalities at some point during their follow-up period. Conclusions: NONHS may be required in a subset of patients with POTS. Those receiving NONHS have more severe symptoms and abnormal GI motility and autonomic testing and exhibit greater healthcare utilization. Management of these patients is complex and challenging and requires a multidisciplinary approach. Further prospective studies are needed to identify optimal management strategies.

KW - dysautonomia

KW - gastrointestinal

KW - nutrition

KW - postural tachycardia syndrome

UR - http://www.scopus.com/inward/record.url?scp=85058703902&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058703902&partnerID=8YFLogxK

U2 - 10.1002/jpen.1493

DO - 10.1002/jpen.1493

M3 - Article

VL - 43

SP - 734

EP - 741

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

SN - 0148-6071

IS - 6

ER -