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Is it hard to convince docs to give IV saline?

Discussion in 'Problems Standing: Orthostatic Intolerance; POTS' started by purrsian, Mar 6, 2017.

  1. Hip

    Hip Senior Member

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    Fair enough, it was just a thought that occurred to me.
     
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  2. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    The important ones are the high affinity antibodies, generally IgG, that confer long term protection, being produced by long lived plasma cells and binding tightly to antigen. IgM and low affinity IgG appear earlier but tend not to be made long term so may serve largely a 'prototype' function that facilitates the development of high affinity IgG through somatic hypermutation and class switching. Useful IgG may well be produced within a week or so but the classic peak is at 20 days.
     
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  3. Hip

    Hip Senior Member

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    Has there been any placebo-controlled trials to determine whether the benefits that these rheumatoid arthritis patients (and other patients) report after receiving IV infusions might actually be due to real physical effects, rather than the assumed placebo effect?

    I am thinking of a trial setup where one group of patients gets a real IV infusion of saline, and the other group has a sham infusion (eg, saline drip needle inserted into their vein, but the drip is not turned on, so no actual saline flows into their bloodstream).

    It seems that if IV infusions do have the reputation for an (assumed) strong placebo effect as you say, somebody ought to test whether it actually is placebo as assumed, or whether it might be a real effect. Especially because I would guess that many studies on infusion-administered drugs might use a pure saline infusion for the control group, so if saline IV had active effects, it would not make a good inert control substance.



    Just another thought: could some sort of antibody and autoantibody protein denaturation occur as a result of IV saline infusion, rendering these autoantibodies non-functional, and thereby providing temporary relief from autoimmune symptoms for some days or weeks?

    Perhaps an osmotic shock effect from the saline infusion? I read that IV saline is typically 0.9% sodium chloride, whereas the blood is 0.6% sodium chloride, so there is a difference in salt concentration, and perhaps there might be some osmotic effects that damage the autoantibodies, and thereby temporarily reduce autoimmune symptoms.


    EDIT: there is an error: the blood is close to 0.9% sodium chloride, not 0.6% as I stated. I read somewhere it was 0.6%, but I think that is a mistake.
     
    Last edited: May 10, 2017
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  4. Jesse2233

    Jesse2233 Senior Member

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    I really think the benefits form saline have to do with blood volume being boosted. There's only so much the stomach can absorb orally, and with low ADH most of it gets dumped immediately to the bladder.

    Futhermore in Dr Bell's work, he found that daily IV saline put some patients into remission and cured two teenage patients who he caught early. If memory serves, 75% of his patients saw a benefit from IV saline.
     
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  5. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    I think you are confusing the physiology here. Fluid taken orally certainly gets dumped in the bladder, but so does fluid taken IV and both have to go via the blood because the bladder only gets fluid from the kidneys and they only get fluid from the blood. So the situation is exactly the same. Moreover, people who drink several pints of beer in an hour (not unusual) will be absorbing fluid from the gut into the blood at least as fast as a 20 minute IV saline infusion.

    This is the problem with all the theories Hip is trying to raise - they apply just as well to drinking a bowl of salty soup.

    If this Dr Bell's treatment really made a big difference why did he not establish the optimal dose and publish proper trials? We are back to the PACE issue of unblinded studies with subjective outcomes.
     
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  6. Hip

    Hip Senior Member

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    I do appreciate what you are saying about oral consumption of salty water ending up in the bloodstream just as IV drip does. And I agree that this makes the benefits that patients report after IV saline seem like they could be the placebo effect.

    At the same time, given the strong benefits reported by patients, it's perhaps worth entertaining a few theories about possible real physical effects that IV saline may have which may not arise from consumption of salty water.

    I just found the following paper, which indicates that there are more complexities and biological effects occurring during saline infusions that one might first think:

    The history of 0.9% saline (full paper here).

    Here is an extract from that paper:
     
    Last edited: May 10, 2017
  7. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    Hip, this is a rather poorly written review produced by a trainee in Nottingham and the last sentence of the abstract shows that he had no real idea what he wanted to say anyway. All the effects mentioned would occur exactly the same with real sodium chloride - that is the point I have repeatedly tried to make. Saline is dangerous if renal homeostasis is impaired as after surgery but every medical registrar should know that. The point the author is probably trying to make is that saline is not necessarily the best fluid for rehydration post-operatively, with dextrose or Hartmann's solution having advantages in some situations. Every medic of my generation knew that. Recent trainees may not have been exposed to the sort of detailed physiological teaching we had forty years ago - everything is now dumbed down. So he is really just talking to the ignorant of his own generation.

    And it makes no difference whatever to what we are talking about !!!
     
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  8. sharks

    sharks Senior Member

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    I'm late to this. But there are services that will go to your house and give you if solutions also some urgent cares will do it too. Some urgent cares take insurance.

    They are mostly marketed towards people with hangovers, but they do the same thing.
     
  9. 900monsta

    900monsta

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    Saying IV fluids are a placebo effect is ignorant. I have CFS, Fibro, POTS and a few other things and IV fluids are the only thing that have helped me. Until you suffer with this or truly deal with patients who do, I think you should refrain from being so disrespectful.
     
  10. barbc56

    barbc56 Senior Member

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    Ha ha, welcome to Phoenix Rising. Congratulations, you stayed right on script! ;)
     
    Last edited: Nov 14, 2017
  11. kisekishiawase

    kisekishiawase sad

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    Gosh the debate...
    From what i know saline can help people with low bp, low electrolyte, low blood volume, etc. (which pots patients have).
    (Ex: treatment for diarrhea)

    And if it does help pots patients whats the problem? It does more good than bad?

    Theres also still a possibility that something missed about the mechanism. Were not God who knows it all. Were human and human makes mistakes/has flaws.
     
  12. pibee

    pibee Senior Member

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    I have no idea where to ask, so to avoid opening new thread i'll ask here:

    In July I got IV saline (think it was 500 mL) because of dehydration -in ER - i had 40 C temp. it was about 4am. Later I got IV rocephine.
    then next day i came for IV rocephine around 10 am.

    felt big impovement that afternoon, about 3pm, and next day whole day. Maybe best I ever felt, with some symptoms at least.

    So could this be IV saline? delay was 35 hrs. Take into consideration that i was not my usual dehydrated, but more, because of 40 C fever
    (that went away on its own beause it was not infection, but drug induced fever, i think.. it happened few times before, as aquired allergy to rifampicin, within 3 hrs of taking it, i get 40 C fever which goes away within 12 hrs with ibuprofen, by the time i got to ER i had 37 C, but i went to have them check my basic functions because i was afraid i'm having sepsis)
     
    Last edited: Dec 12, 2017 at 6:20 PM

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