Get Flare-ups Back on Track:
Managing Fluids, Salt and Activities

You have reviewed the questions and decided you were ok right now to take care of this at home. The suggestions here might help get things back under control. HOWEVER - if they do not help and you are feeling worse or not making any progress after a day or two, check with your physician. If your symptoms get worse, go back to the questions to see if you need to be seen by a physician for evaluation and management.

If you did not answer yes to the questions above or you don't think you are bad enough for an ER visit, then try these things. Your physician might have other suggestions. It is best if you go over the suggestions before you develop problems - but that doesn't always work. (Maybe before it happens again!)

Remember - figure out what triggered it and deal with - Dealing With the Trigger. If you don't deal with it, you will find it challenging - or impossible - to get this episode under control. Or, if you get it under control, it can start over again.


What To Do Now with Fluids & Salt

  • Try the Water Trick Chug 16 oz (2 cups) over 15 minutes plus 1-2 gm of salt.
  • Over 4 hours – If you are having a lot of symptoms, try this approach. Drink about 5 - 8-ounce servings of fluid and more salt (2-4 gm) over 4-5 hours.1
    • Bottled water is 16 fl oz - That would be 2 1/2 bottles. Try drinking 1 bottle every hour and a half.
    • Salt - this can be hard on the stomach. Eat something light with it - a few crackers, fruit, toast.
  • Over a day – Drink 6 - 16 oz bottles of water (or drink 12 glasses of water/fluids) plus take in salt -2 g three times a day. Take the salt in every couple of hours with the fluids.1
    • Try to get in 12 8-ounce servings (6 -16 oz water bottles).
    • For some people, it's easier to drink 1-16 ounce bottle every 1-1 1/2 hours.
    • Remember - things like jello, soup, ice cream/soy ice cream, sorbet all count as liquids too. Herbal teas help break up the taste boredom. Juices and soda are ok - keep an eye on the amount of sugar drinks. If you are not able to eat much, they can help.

If this is not working - contact your doctor. If you are feeling worse, go back over the questions, contact your doctor! If you cannot talk with the physician right away, leave a message with the details for his nurse/assistant to relay to the physician. If that doesn't work, consider Urgent Care or the ER.


Dr. Figueroa recommends taking Fludrocortisone (Florinef) 0.2 mg three times a day for 1 week (or increase your dose if you are taking it). However, before making any changes to your Fludrocortisone doses, talk with your doctor. Increases need to be managed with physician oversight and monitoring the blood pressure. It can increase blood pressure to unsafe levels if too much is taken.


Other things to do

An abdominal binder or corset, full-leg support stockings or sports shorts will definitely help when you are up. Even if you don't wear one usually, this is a good time to try it out.

If these things help, keep it up:

  • Make sure you get at least 8 – 8 oz of fluid (2-3 liters) and 3-4 g of salt over the next 3-5 days. (Remember - soup, jello, pudding, popsicles, sorbet - they all count!)
  • Take your other medications. 
  • Move carefully when you go from standing or sitting to standing up and moving around. 
  • Avoid getting hot, hot showers, crowds or hot room temperatures.
  • Lighten up on your standing activities until your symptoms, blood pressure & pulse settle down.
  • Take a look at your activity/movement routine.
    • Generally, the recommendation is to cut your routine in half. It that is still too much, cut it down more.
    • You could still do some of your activities lying down.
    • If you have CFS or are really sick in bed, just focus on moving your arms and legs around and rolling from side to side, front to back.
  • If you are resting more of the day, try resting in a recliner with your head above the rest of your body and your legs up.

If the trigger is an infection or something that is going on for a few days, keep it up. Keep an eye on your fluids and salt intake and do your best to keep up.

Managing the Trigger at Home

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  1. Figueroa JJ, Basford JR, Low PA.    Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010 May;77(5):298-306. Abstract --- Article PDF
  2. Rowe, Peter.  General Information Brochure on Orthostatic Intolerance and Its Treatment. June 2010. Accessed from http://www.cfids.org/webinar/cfsinfo2010.pdf. Accessed May 28.2012.
  3. Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ and Fischer PR. Postural Orthostatic Tachycardia Syndrome: A Clinical Review. Pediatr Neuro 2010; 42:77-85. Abstract.

Author: Kay E. Jewell, MD
Page Last Updated: August 6, 2012