Fluids Are Essential in Everyday Living!

No matter what type of OI you have or what has caused it, getting enough fluids and salt is the first thing to do - every day.

People with orthostatic intolerance (OI) due to neurally-mediated orthostatic hypotension (NMH) or Postural Orthostatic Tachycardia Syndrome (POTS) have a low blood volume. By itself, this would cause orthostatic problems!

The first thing to do is increase fluids and salt so the blood volume increases. To find out more about low blood volume and orthostatic problems, check out the information about the body.

The body needs enough fluid to fill the the vessels and get enough blood up to the head. The medications that change the blood vessels and pulse don't work as well if there is not enough blood for the heart to pump around.


  • What's Enough?
  • What kind?
  • When?
  • Caffeine?
  • TIps
  • Watch out for!
  1. You need at least 2 liters a day. Aim for 2 to 3 liters of fluid a day. Some recommend 3-4 liters.1,3
    • That would be 4 - 16 oz bottles of water to make 2 liters.
    • 3 liters is 8 of the 16 oz bottles of water. A soda can is 12 oz. or 360 ml.
    • The recommended intake for "normal" people is 1.5 liters (about 8 glasses).

  2. Drink something about every 2 hours throughout the day.

  3. If you get dizzy when you get up in the morning - drink 16 ounces - that's 2 cups (500 cc - 1 16-oz-bottle)of water in about 15 minutes. Wait another 15 minutes and then get up.4   See "The Water Trick".

Just about any fluid will help.

  • Water
  • Herbal tea
    • Either hot or cold.
    • There are a lot of teas available.
  • Soda
    • Soda is one option but there are some precautions
    • Preferred: Seltzer, non-cola soda
      • Caution with soda: "Empty calories" and sugar effect on teeth..
      • Avoid colas: They have a negative effect on bones.
  • Fluids with more salt in them:
    • Examples: Pedialyte™, Gatorade™, G-2™, Powerade™, Propel™
    • Benefit:
      • You get both - fluid + salt
      • Different flavors!
      • They are easy to carry around, take with you especially on hot days
    • Limits - Drawback:
      • Chemical taste - if you are sensitive to chemicals, this could be a drawback
      • Cost - watch for sales/specials
      • Salt can get irritating to the stomach, even the fluids with salt will bother.
  • Anything liquid - or that turns to liquid when it gets inside your body
    • Soup - Especially ones that don't have stuff - a lot of vegetables-meat-pasta in them: tomato soup, packaged chicken noodle soups
    • Jello - turns to liquid in your body
    • Popsicles
    • Sorbet (Sherbert - has milk products/sugar in it but it usually costs less)
    • Ice cream
    • Milk - cow's, goal, soy
    • Others: almond, rice, coconut milk
    • Fruit granitas
    • Seltzer with herb mixtures for flavor
  • Drinks with caffeine - Check out the "Caffeine" tab.
  • It's better not to drink all your fluids at once or all in the morning. Definitely not at bedtime!.

  • Start when you wake up. If you tend to get dizzy when you get up or you feel especially thirsty when you wake up, start with the "bolus"- 250-500 cc (2 cups).

  • Spread it out over the day. Try to drink 1-2 cups every 2 hours.2,11

  • If you are going to be up more or doing something that might set off your OI symptoms, drink extra before you go out or start and take extra with you. See "The Water Trick" for more details.

  • Some recommend drinking a glass of something with your meal. For some stomach problems, it's better to drink less at meals. You will need to see what works best for you.

  • If you sleep more than 12 hours or are "resting" long hours,    you might need help getting the fluids in. It can help if someone keeps track of the time (ie with a timer) and brings about 16 oz (1 water bottle or 2 cups) of water/fluid to you every 1 1/2 hour.

    • It has been our experience that it is hard to drink a lot sooner than every 1 1/2 hour. The stomach is "full".

    • You might have a different experience - you might be able to drink 8 oz ( 1 cup) every hour. Each person needs to find out how much they can drink and how soon.

Caffeine is thought to have 2 effects on the body.

  1. It can be a stimulant, like adrenaline (catecholamines). It is also thought to have a "diuretic" effect. A "diuretic" makes you urinate more, lose water.
  2. Adrenaline or stimulants can trigger low BP - so most recommend avoiding caffeine. See topic: What Makes OI Worse.
    Some people do better with 2 cups of coffee or caffeine in the morning and then avoiding it the rest of the day.

  3. As a diuretic - A recent analysis of the literature about the effects of caffeine with exercise raises a question about whether it has a serious diuretic effect.

Caffeine in fluids:
    •  Standard coffee
    •  Black tea
    •  Green tea
    •  Colas and Energy drinks - the label usually lists how much caffeine is in the product.

Having fluids ready and available really helps. If you have to fuss to get the fluid - it's easier to just skip it.


A small cooler that holds about 6 bottles/cans. You can keep it at the bedside or your chair. To keep it cool, take 2 empty water bottles, fill them up with tap water, leave about 1 inch to the top. Freeze them. Put them in the cooler with the other bottles. It will keep them cool. (If you have 4 bottles, you can keep 2 in the freezer and 2 in the cooler. That way, you have cool bottles if you forget to refreeze them at the end of the day.)

A small refrigerator just for liquids. If you are bed bound, find a space for it in the room with the bed. Even if you don't have the energy to get up and down to get the fluids, it helps your caregiver if they are handy.

Make batches of tea ahead of time, like 8-10 cups. Cool them down in a pitcher. Use either the cups with covers/straws or pour them into an empty water bottle and keep it in the refrigerator.

Keeping track of the amount: You will need to find what works for you.
    •  Leaving the bottles in a special place so you can count them up at the end of the day
         (but this doesn't keep track of the cups/glasses).
    •   Use a white board to keep track.

High sugar drinks - be sure to brush your teeth!

'Empty Calories' - That usually means something with high calories from sugar/fructose with little other nutrition. You might need to pay special attention to the calories in your liquids If you have been gaining more weight than you intend to, have diabetes or are pre-diabetic, or have metabolic syndrome,

Sweeteners for tea - There are sweeteners that do not have the same calories as table sugar. You might want to check them out to see what you think about the taste. They are natural but some have a unique taste to them. Of course, there are the diet sweeteners if you prefer.

Other sweeteners: Stevia, Truvia, xylito,


Salt - How Much, What Kind, Is it safe and more

  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. #103Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20. Abstract.
  4. #14 Figueroa
  5. #90Freeman, Roy. Neurogenic orthostatic hypotension.NEJM 2008;358(6):615-624. Abstract
  6. Jordan J, Shannon JR, Black BK, et al. The pressor response to water drinking in humans: a sympathetic reflex? Circulation . Am J Med 2002; 112:355–360.
  7. Shannon JR, Diedrich A, Biaggioni I, et al. Water drinking as a treatment for orthostatic syndromes. Am J Med 2002; 112:355–360.
  8. 124. Lu C-C, Diedrich A, Tung C-S, et al. Water Ingestion as prophylaxis against syncope. Circulation. 2003;108:2660 –2665.
  9. 509. Jordan J, Shannon JR, Grogan E, Biaggioni I, Robertson D. A potent pressor response elicited by drinking water. Lancet. 1999 Feb 27; 353(9154):723. Abstract .
  10. # 178 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.
  11. Rowe, Peter. Managing Orthostatic Intolerance. Webinar. September 1, 2010. Hosted by CFIDS Association of American. Accessed June 1, 2012.  Written material.  Slides PDF.   Video.

Author: Kay E. Jewell, MD
Page Last Updated: May 31, 2012