What is the evidence for adding oral rehydration solutions (Hydralyte), an electrolyte supplement, to meals as a conservative treatment option for orthostatic hypotension?

From the Guidelines

The addition of Hydralyte supplements to meals is not a recommended treatment for orthostatic hypotension based on the available evidence, and instead, patients should focus on increasing their salt and fluid intake through other means, such as consuming 2-3 liters of fluid daily and 10-12 grams of sodium per day, unless contraindicated by other conditions 1.

Rationale for Recommendation

The rationale behind this recommendation is based on the well-established conservative treatment approach for orthostatic hypotension, which involves increasing salt and fluid intake to expand blood volume and help maintain blood pressure when changing positions. While Hydralyte is an oral rehydration solution containing electrolytes that can help maintain fluid balance, it has not been extensively studied for orthostatic hypotension management.

Key Points to Consider

• Increasing salt and fluid intake is a well-established conservative treatment approach for orthostatic hypotension, with patients typically advised to consume 2-3 liters of fluid daily and increase sodium intake to 10-12 grams per day (unless contraindicated by other conditions like heart failure or kidney disease) 1.
• Electrolyte supplements like Hydralyte could theoretically help achieve this goal by providing sodium and promoting fluid retention, but regular table salt added to meals or salt tablets are more commonly recommended in clinical practice 1.
• The physiological basis for this approach is that increased sodium and fluid intake expands blood volume, which can help maintain blood pressure when changing positions.
• Before using any electrolyte supplement for orthostatic hypotension, patients should consult their healthcare provider, as excessive sodium intake can be harmful for those with certain medical conditions.

Additional Considerations

Other treatment options for orthostatic hypotension, such as midodrine, fludrocortisone, and physical counterpressure maneuvers, may be considered in addition to increasing salt and fluid intake, depending on the individual patient's needs and medical history 1.

From the Research

Orthostatic Hypotension Conservative Treatment Options

• There is no direct evidence to support the addition of Hydralyte supplement to meals as a conservative treatment option for orthostatic hypotension 2, 3, 4, 5.
• However, increasing fluid and salt intake is considered a mechanical and positional measure to help manage orthostatic hypotension 2.
• Maintaining adequate hydration is also recommended as a nonpharmacological strategy to treat primary orthostatic hypotension 5.
• Water has numerous roles in the human body, including acting as a solvent, reaction medium, and reactant, and regulating water balance is essential for maintaining health and life 6.
• Dehydration can affect consciousness and induce symptoms such as orthostatic hypotension and tachycardia, highlighting the importance of adequate hydration 6.

Nonpharmacological Strategies for Orthostatic Hypotension

• Nonpharmacological strategies are the primary treatment for orthostatic hypotension, including discontinuing offending medications, switching medication administration to bedtime, avoiding large carbohydrate-rich meals, limiting alcohol, and maintaining adequate hydration 5.
• Adding salt to the diet is also recommended as a nonpharmacological strategy to help manage orthostatic hypotension 5.
• These strategies can help ameliorate symptoms and improve quality of life for patients with orthostatic hypotension 4, 5.

Pharmacological Treatment Options for Orthostatic Hypotension

• Fludrocortisone is considered a first- or second-line pharmacological therapy for orthostatic hypotension, although it is associated with adverse events including renal and cardiac failure and increased risk of all-cause hospitalization 2, 4.
• Midodrine and droxidopa possess the most evidence with respect to increasing blood pressure and alleviating symptoms of orthostatic hypotension 5.
• Pyridostigmine and fludrocortisone can be used in patients who fail to respond to these agents, and emerging evidence with low-dose atomoxetine is promising, especially in those with central autonomic failure 5.