Postural orthostatic tachycardia syndrome in patients with alcohol use disorder: a case series

Postural orthostatic tachycardia syndrome (POTS) is an under-recognized complication of chronic alcohol use and withdrawal. Autonomic dysfunction secondary to alcohol-related neuropathy may manifest as POTS during or after the deaddiction process. This case series describes eight patients who developed POTS while undergoing detoxification and deaddiction treatment. We retrospectively reviewed medical records of four patients admitted to Dr. B. C. Roy Hospital for alcohol deaddiction during 2024-2025 who presented with POTS symptoms during their treatment. All four patients (4 males; mean age 34.25 years) with chronic alcohol use disorder (mean duration 12.4 years) developed orthostatic intolerance symptoms during detoxification or early recovery phase. Tilt table testing or active stand tests confirmed inappropriate tachycardia (≥30 bpm increase) upon postural change. Symptoms significantly impacted rehabilitation outcomes, requiring integrated management approaches. POTS represents an important autonomic complication in alcohol deaddiction patients that requires systematic evaluation and may impact recovery outcomes. Recognition and management of POTS should be integrated into comprehensive alcohol rehabilitation programs.