What is a common treatment to increase intravascular volume in patients with multiple system atrophy?

Fludrocortisone is commonly used to increase intravascular volume in patients with multiple system atrophy (MSA), particularly in those who experience orthostatic hypotension. MSA is characterized by a combination of neurodegenerative symptoms, including autonomic dysfunction, which can lead to cardiovascular issues like low blood volume and poor blood pressure regulation.

Fludrocortisone is a mineralocorticoid that promotes sodium retention in the kidneys, leading to an increase in extracellular fluid volume and ultimately enhancing intravascular volume. This can help combat the hypotension and dizziness that patients with MSA may experience upon standing.

In contrast, hydration therapy alone may not effectively manage the long-term volume depletion or orthostatic symptoms in these patients. Diuretics would exacerbate fluid loss rather than retain fluid, making them counterproductive in this context. Beta-blockers could potentially worsen orthostatic hypotension in these patients, as they can reduce heart rate and cardiac output, further complicating blood pressure management.

Therefore, using fludrocortisone is a rationale and effective approach to increasing blood volume in individuals with MSA and its associated cardiovascular challenges.