Idiopathic Hypovolemia - (Low Blood Volume)

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Dr. Bell mentioned that idiopathic hypovolemia might be similar to what is seen in ME/CFS. The below paper suggests this condition may be triggered by surges of dopamine sulfate
Clin Auton Res. 1998 Dec;8(6):341-6.Idiopathic hypovolemia: a self-perpetuating autonomic dysfunction?Kuchel O1, Léveillé J.Author information

Abstract

Unexplained episodic hypertension, hypotension, or orthostatic intolerance, tachycardia, anxiety, and flushing in 21 patients were investigated for the possibility of hypovolemia by blood volume and individual plasma catecholamines (including autocrine paracrine-born dopamine), determinations baseline, in response to upright posture and catecholamines only during the episodic blood pressure swings. Blood volume was determined by Cr51 fixed to patients' hemoglobin, free norepinephrine, epinephrine, and dopamine with dopamine sulfate following sulfatase hydrolysis, radioenzymatically.

The recumbent mean 27.4+/-3% (SE) blood volume decrease from predicted values accentuating to 33.5+/-4% upright was associated with normal baseline plasma free norepinephrine, epinephrine, dopamine, dopamine sulfate, plasma renin activity, and aldosterone with normal mean postural responses from all patients except a hyperresponsive compared to controls (p < 0.04), plasma renin activity increase from 0.657+/-0.1 to 4.47+/-1.8 ng/mL/hr.

During the hypertensive, hypotensive, or tachycardic episodes the moderate increase of free norepinephrine and epinephrine (p < 0.04) (but not free dopamine) contrasted with an increase of dopamine sulfate from 2.5+/-0.9 to clearly pathological values of 16.8+/-8.3 ng/mL (p < 0.0003 on % increase of individual values).

We conclude that the normal (but to the degree of hypovolemia inappropriately low orthostatism- and episodes-associated sympathetic arousal) is outpaced by considerable episodic dopamine sulfate surges, reflecting extraneuronal dopamine discharge. Whether this increase contributes to the increased natriuresis directly or by inhibiting aldosterone response to renin-angiotensin, perpetuating hypovolemia, remains to be established.
PMID:
9869552
[PubMed - indexed for MEDLINE]
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Wow, that is technical. I could use a translation. But thanks!
Me too but I think I got it!

Everything was normal in these patients except plasma renin shot up. Surges in dopamine can suppress the aldosterone -renin system which increases the reabsorption of sodium and water into the blood increasing blood volume. Except plasma renin was high - so I don't get it either :)
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
This has been looked at in at least one study. It was published by one of the ME ICC authors, Kunihisa Miwa.

Renin–aldosterone paradox in patients with myalgic encephalomyelitis and orthostatic intolerance

They did not find any statistically significant differences with plasma renin levels. They did find that plasma aldosterone was significantly lower in the ME patients.
It sounds like they need more studies. They found something significant in aldosterone levels - but it was apparently never followed up on. Dr. Klimas has said the IOM group found many examples of this. The lack of validation studies prevented them from saying more about ME/CFS.
 

Issie

Well-Known Member
With me, I have low renin and aldosterone. I also have HYPERPOTS with high NE levels. The subset type of POTS I have gives me higher blood pressure with drops more into a normal range that causes Orthostatic issues with dizziness and near faints. I have weak kidneys and was in CKD stage 3. Florineff was a horrible trial as was increasing salt. I do have pooling and low blood volumes - but increasing fluids by holding on to Salt is NOT - with a logical thinking mind - the right thing for me with my complexities. Thankfully I paid attention to what my body was telling me and stopped what I consider was very dangerous for me. Also another medicine commonly used in POTS is middodrine which causes constriction of blood vessels to supposedly get blood up to heart and head. But if we are overly constricted (biofilm with protozoa, clogged veins, issues with function of veins to expand or contract for whatever reason) this could compound an already too tight or too small vein and blood flow could be even slower and have more issues getting where it needs to go.

We need to make sure we know what we are dealing with - before we throw medicine at it. If I hadn't had such a through work up on my POTS, and me researching it so much - I think I would have gone into complete renal failure had I not figured out what the med was doing to me and that I was already overly constricted. The Mayo kidney specialist said that normally with kidney function like mine with low renin and aldosterone - they normally would RX heavy duty diuretics. But with me having POTS of course, that wouldn't be done with low volume.

Changing my diet has reversed my Chronic Kidney Disease. I'm near normal now. I'm still living with POTS and forever trying to manage the protozoa and Lyme. These things I've concluded may be a lifelong thing. But I'm so much better than I was.

Issie
 

weyland

Well-Known Member
I have read that florinef and salt/water loading are not recommended for the hyperadrenergic form of POTS.
 

Issie

Well-Known Member
I have read that florinef and salt/water loading are not recommended for the hyperadrenergic form of POTS.
Alot has been learned in the last 5 years. Thankfully we are figuring out the subsets. We cannot all be treated the same.

I'm not convinced that many of the treatments used are in the long term "good" I think they could have bad consequences.

Issie
 

weyland

Well-Known Member
I'm not convinced that many of the treatments used are in the long term "good" I think they could have bad consequences.
Agreed. From what I've read beta blockers might lead to mast cell issues and long term use of things like Midodrine can actually worsen low blood volume over time.

It's clear that none of the treatments used are very effective and I think we need to figure out what's underlying the conditions instead of just treating the symptoms.
 

Issie

Well-Known Member
YES!!!!!! And the tachycardia with all the discomfort that brings - probably is compensating for what the rest of our body isn't doing adequately enough.

You are right. I have MCAS and beta blockers were horrible. I've tried everything they throw POTS way. The things that help me the most address my immune system, inflammation and vasodilation (but only to a point) and since I also have EDS and FMS things to help with inflammation.

We need to address the CAUSE, but if a "bandaid" doesn't cause more harm - I'm glad to have the ones that help.

Issie
 
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