From the Guidelines
For a patient with POTS undertaking a 12-hour drive, it is crucial to prioritize strategies that maintain blood volume, prevent venous pooling, and stabilize blood pressure to prevent symptom exacerbation. To achieve this, several evidence-based recommendations can be made.
- Ensure adequate hydration by drinking 3 liters of water or an electrolyte-balanced fluid per day 1, with added electrolytes such as salt (5-10g or 1-2 teaspoons of table salt per day) to help maintain blood volume.
- Take frequent breaks every 1-2 hours to walk around and prevent blood pooling in the lower extremities, which can help reduce the risk of symptom exacerbation.
- Wear support stockings (waist-high) to ensure sufficient support of central blood volume 1, which can help improve venous return and reduce symptoms.
- Consider taking prescribed medications like midodrine (2.5-10mg) or fludrocortisone (up to 0.2 mg taken at night) as directed before and during the trip to help manage orthostatic intolerance and increase blood volume 1.
- Maintain a consistent eating schedule with small, frequent meals to avoid post-prandial symptom worsening, and avoid factors that contribute to dehydration such as consumption of alcohol and/or caffeine, ingestion of large heavy meals, and excessive heat exposure 1.
- Keep the vehicle cool to prevent heat-induced symptom exacerbation, and have someone else drive if possible, as the stress of driving can worsen symptoms. These recommendations are based on the most recent and highest quality study available 1, and prioritize the patient's morbidity, mortality, and quality of life as the primary outcome.
From the Research
Preventing Exacerbation of POTS Symptoms During Long Drives
To prevent exacerbation of POTS symptoms during a 12-hour drive, the following measures can be taken:
- Frequent breaks: Stop every hour to get out of the car and stretch, as prolonged sitting can worsen POTS symptoms 2.
- Stay hydrated: Drink plenty of water and electrolyte-rich fluids to prevent dehydration, which can trigger or worsen POTS symptoms 3.
- Avoid triggers: Identify and avoid triggers that can worsen POTS symptoms, such as certain foods, stress, or extreme temperatures 4.
- Medication management: If the patient is taking medication for POTS, ensure they take it as prescribed and consider adjusting the dosage or timing to accommodate the long drive 5.
- Comfort measures: Use comfortable clothing, adjust the car seat and temperature to a comfortable position, and consider using a cushion or back support to reduce discomfort and fatigue 2.
Additional Considerations
- Consider having a companion: Having someone accompany the patient on the drive can provide emotional support and help in case of an emergency 3.
- Plan for emergencies: Keep a first-aid kit and a list of emergency contact numbers in the car, and consider investing in a roadside assistance service 4.
- Monitor symptoms: Encourage the patient to monitor their symptoms and take regular breaks if they experience any worsening of symptoms, such as increased heart rate, dizziness, or nausea 5.