Research Spotlight: IV Saline Therapy for Postural Tachycardia Syndrome (POTS)

A 2017 observational study published in the Journal of Interventional Cardiac Electrophysiology (Ruzieh et al., University of Toledo) examined the impact of intermittent intravenous saline infusions on 57 patients suffering from medication-refractory POTS — patients who had already tried, on average, 3.6 medications without adequate relief.

Patients received approximately 1.5 liters of IV saline roughly every 11 days. Outcomes were measured using two validated tools: the Orthostatic Hypotension Questionnaire (OHQ), which tracks symptom burden, and the SF-36 Health Survey, which captures overall quality of life.

The results were striking. Patients showed statistically significant improvement across every composite score on the OHQ (mean change 3.1, P < 0.001) and a substantial gain in quality of life on the SF-36 (mean change 19.1, P < 0.001). The authors concluded that intermittent IV saline infusions “dramatically reduce symptoms and improve quality of life” in POTS patients and may serve as an effective bridge therapy for those with severe symptoms. Sjogren et al also report the benefits of IV Therapy.

Why The Fascia Institute and Treatment Center Supports IV Therapy

This study reinforces what we see clinically every day: when oral hydration and medications fall short, direct intravascular volume loading can restore the effective circulating volume that POTS patients lose to blood pooling — quickly, predictably, and with measurable improvements in both symptoms and daily function. For patients whose orthostatic intolerance, fatigue, brain fog, and tachycardia have not responded to conventional therapy, peer-reviewed evidence like this supports IV hydration as a safe, well-tolerated, and meaningful option within a comprehensive treatment plan.

Why We Often Reach for Plasma-Lyte

Not all IV fluids are created equal. The bag hanging on the pole matters — and for many of the patients we treat, the choice between normal saline, Lactated Ringer’s, and Plasma-Lyte can meaningfully shape how they feel both during and after an infusion.

Normal saline (0.9% sodium chloride) is the most familiar IV fluid and works well for everyday depletion and general volume restoration. But it contains only sodium and chloride, and at concentrations notably higher than what circulates in healthy human plasma. In larger volumes or repeated infusions, that chloride load can nudge the body toward a mild metabolic acidosis and place added demand on the kidneys.

Lactated Ringer’s is a step closer to physiologic. It adds potassium and calcium, lowers the chloride content, and includes lactate as a buffer — which the liver converts to bicarbonate to support acid-base balance. It’s a strong option for recovery after illness, heat or exertion-related depletion, and situations calling for broader electrolyte support.

Plasma-Lyte is the most balanced of the three and the one we most often select for our patient population. Its electrolyte profile — sodium, potassium, magnesium, chloride, acetate, and gluconate — is specifically designed to mirror the composition of human plasma. The acetate and gluconate buffers provide acid-base support without relying on lactate metabolism, and the inclusion of magnesium is meaningful for many of the patients we see, particularly those with POTS, dysautonomia, MCAS, and hypermobility-spectrum conditions who are often sensitive to fluid shifts and electrolyte changes. Because Plasma-Lyte more closely resembles the body’s own internal environment, it tends to be physiologically gentler — minimizing the chloride burden of saline while avoiding the calcium content of Lactated Ringer’s, which can complicate compatibility with certain medications and blood products.

For patients with higher hydration demands, repeated infusions, or complex autonomic and connective tissue conditions, this closer-to-plasma profile is why Plasma-Lyte is frequently our preferred choice.