Orthostatic Hypotension Table 5 Fluid and Salt Intake for Management of OH in SCI

Author Year; Country
Research Design
Total Sample Size



Frisbie 2004; USA


Population: Chronic cervical complete tetraplegia; AIS A
Treatment: Evaluation of urinary salt and water output in relation to prescribed dosage of ephedrine (doses range from 0 to 100 mg daily)
Outcome Measures: Severity of OH, urinary output.
  1. With decreasing ephedrine dose (and OH severity), there was a mean increase in daily output of urine sodium (from 50 to 181 mEq), water (from 1.5 to 5.3 L),rate of creatinine secretion, sodium concentrations, and rates of water excretion, and a decrease in urine osmolality.

Frisbie & Steele 1997; USA


Population: SCI; Ephedrine (medically treated for OH) group: mean(SD) age 57(15) yrs, mean(SD) duration of paralysis 26(15) yrs; No ephedrine group: mean(SD) age 51(15.2) yrs, mean(SD) YPI 22(13.5).
Treatment: Retrospective chart review of use of ephedrine (n=30), sodium/salt supplementation (n=6), fludrocortisone (n=3) or physical therapy.
Outcome Measures:OH symptoms, serum sodium and urine osmolality.

  1. 3/4 patients on ephedrine who started salt supplementation with meals became independent of ephedrine use.
  2. Symptoms of OH were reduced consciousness (100% of subjects), strength (75%), vision (56%) and breath (53%). Precipitating factors were hot weather (77%) bowel care (33%) and meals (30%).
  3. Low blood sodium found in 54% of the ephedrine (OH) patients and 16% of those without.

Muneta et al. 1992;


Case Report

Population: 72-year old woman with non-traumatic SCI and paroxysmal hypotension.
Treatment: Several weeks of salt/sodium supplement (7 then 15 g/day) was followed by L-threo-3,4-dihydroxyphenylserine (100 mg up to 600 mg/day)
Outcome Measures: Blood pressure, catecholamines (epinephrine & non-epinephrine), plasma renin activity.

  1. After salt supplement, a marked increase in BP and norepinephrine were observed in response to sitting, along with a decrease in basal plasma renin activity.
  2. Addition of L-threo-3,4-dihydroxyphenylserine for 2 weeks, showed elevation in catecholamines about 5 and 10 times without an apparent increase in resting BP level.
  3. Significant improvement in the symptoms of the paroxysmal hypotension and patient able to participate in rehabilitation program.