Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review.

Q2 Medicine Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI:10.5863/1551-6776-29.5.456
Peter Huynh, Alex Brown, Lauren Campisi, Allison Mruk, Tran Nguyen, Mike Raschka, Titilola Afolabi
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Abstract

Postural orthostatic tachycardia syndrome (POTS) is a chronic illness with unknown mortality and high morbidity, often diagnosed in the adolescent years. Published literature regarding POTS primarily focuses on the adult population, and guidance on treatment in pediatrics is sparse. The purpose of this clinical review is to evaluate the current literature on the management of POTS in pediatric patients. A search was conducted using the Cochrane database, Google Scholar, and PubMed. Studies were included if they evaluated the management of POTS, primarily in pediatric patients. Case reports and series were excluded. Eight published studies met the inclusion and exclusion criteria. To date, there are no US Food and Drug Administration-approved agents for the treatment of POTS. However, select pharmacological therapies have shown positive outcomes by addressing symptom origins, such as providing heart rate control, peripheral autonomic modulation, and targeting hypovolemia. Targeted pharmacological therapies studied in children and young adults include ivabradine, metoprolol, midodrine, pyridostigmine, intravenous crystalloid fluids, and fludrocortisone. Before adding pharmacotherapeutic interventions, non-pharmacologic interventions such as patient education, avoidance of symptom-triggering environments and medications, dietary fluid and sodium supplementation, exercise, and use of compression garments should be first attempted. Although the body of evidence for the management of POTS is expanding, additional research is needed to determine safe and efficacious dosing and establish clear guidelines for POTS in the pediatric population.

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儿科患者体位性正位性心动过速综合征的治疗:临床回顾。
体位性正位性心动过速综合征(POTS)是一种慢性疾病,死亡率未知,发病率高,通常在青少年时期被诊断出来。已发表的有关 POTS 的文献主要集中在成人人群,而有关儿科治疗的指导却很少。本临床综述旨在评估当前有关儿科患者 POTS 治疗的文献。我们使用 Cochrane 数据库、Google Scholar 和 PubMed 进行了检索。主要针对儿科患者的 POTS 治疗进行评估的研究均被纳入其中。病例报告和系列研究除外。八项已发表的研究符合纳入和排除标准。迄今为止,美国食品和药物管理局尚未批准用于治疗 POTS 的药物。不过,部分药物疗法通过解决症状根源(如控制心率、调节外周自律神经和针对低血容量)取得了积极疗效。在儿童和青少年中研究的针对性药物疗法包括伊伐布雷定(ivabradine)、美托洛尔(metoprolol)、米多君(midodrine)、吡啶斯的明(pyridostigmine)、静脉注射晶体液和氟柔可的松(fludrocortisone)。在增加药物治疗干预措施之前,应首先尝试非药物干预措施,如患者教育、避免诱发症状的环境和药物、饮食中补充液体和钠盐、运动和使用压力衣。尽管治疗 POTS 的证据不断增加,但仍需开展更多研究,以确定安全有效的剂量,并为儿科人群的 POTS 制定明确的指导原则。
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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
期刊最新文献
Ketorolac Dose Ceiling Effect for Pediatric Headache in the Emergency Department. Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review. Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review. Pharmacogenomics in Pediatric Oncology Research and Treatment. Propranolol As a Treatment Option for Chylous Effusions and Chylous Ascites in Fetuses and Neonates: A Systematic Review.
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