The pots (Postural tachycardia syndrome) epidemic: Hydration and nutrition issues

Postural tachycardia syndrome (POTS) is one of the most common causes of orthostatic intolerance and is being increasingly recognized in clinical practice. A variety of non-orthostatic symptoms including gastrointestinal (GI) symptoms are also reported commonly in patients with POTS and pose a considerable management challenge, occasionally resulting in problems maintaining hydration and nutrition. The available evidence suggests that GI dysmotility occurs in POTS and may represent an important pathogenic mechanism. At present, the evaluation and treatment of POTS remains largely empirical. General lifestyle modifications to treat POTS may lead to improvement in both GI and non-GI symptoms, at least in the milder form of POTS. Symptoms refractory to these measures should prompt further diagnostic evaluation and appropriate dietary, pharmacologic and nutrition support management options. This review includes a brief background on POTS, conditions associated with POTS, and an overview of management including nutrition and hydration support.