Abstract P066: Case Report on IV Albumin in Postural Orthostatic Tachycardia Syndrome with Meniere’s Disease

Abstract

Postural orthostatic tachycardia syndrome (POTS) is characterized by an increase in a patient’s heart rate when they move from a supine to an upright position. This syndrome is often treated with a high sodium diet. Meniere’s disease is a disorder of the inner ear generally treated with diuretics and a low sodium diet. This poses a challenge when treating a patient suffering from both Meniere’s and POTS because by treating the Meniere’s with diuretics and a low salt diet it will exacerbate the symptoms of POTS. We hypothesize that the administration of IV albumin will result in an increase in the plasma oncotic pressure thus intravascular volume while simultaneously decreasing extra cellular fluid pressure therefore leading to an improvement in the patient’s symptoms.

This case involves a 35-year-old female suffering from low blood pressure, debilitating dizziness with fainting, shortness of breath with exercise intolerance, and chest pain that was sent to us for further evaluation and treatment of her symptoms. Growing up she had several recurring ear infections, and by the age of 30, she started developing symptoms of vertigo and dizziness that had no relationship to posture. She was diagnosed with Meniere's disease. The patient appeared to have primarily vestibular-type symptoms. Her tilt table was indicative of POTS. Her clinical symptoms were partly reproduced during the tilt table test. We were not able to completely alleviate the patient’s symptoms by the administration of Midodrine. Intravenous treatment with Albumin and saline was started which was changed to treatment with IV Albumin alone. The patient reports improvement of her symptoms.

We hereby suggest the use of IV albumin in the treatment of POTS in a patient with Meniere’s disease.