Steps of Care to a patient with orthostatic hypotension secondary to dysautonomia
- Avoid straining, which results in the Valsalva maneuver, by treating and preventing constipation with a high-fiber diet.
- Avoid severe diurnal variation, particularly morning postural hypotension, by head-up tilt or sleeping in a sitting position at night, sitting for several minutes at the edge of the bed before standing and shaving while sitting.
- When presyncopal symptoms occur immediately assume a squatting position, cross the legs, bend forward and place the head between the knees, or place one foot on a chair.
- Avoid exposure to a warm environment to prevent uncompensated vasodilation (e.g., travel to warm countries, hot baths).
- Avoid postprandial aggravation of orthostatic hypotension by eating smaller and more frequent meals with reduced carbohydrate content.
- Avoid a low-sodium diet by increasing the food sodium content to at least 150 mEq.
- Avoid dehydration by increasing fluid intake to 2.0 to 2.5 L/day.
- Avoid vigorous exercise; moderate isotonic exercises are preferable to isometrics.
- Avoid prolonged recumbency.
- Avoid vasodilators such as alcohol.
- Avoid drugs known to cause vasodilation and/or bradycardia (nitroglycerin or beta-blockers).
