Differential diagnosis reviewed.
Orthostatic vitals.
Medication review was done. All offending medications discontinued. Patient instructed to take offending meds that can’t be discontinued at bedtime, e.g. BP medications.
Head-up tilt-table testing.
Patient assessed for neurologic causes of orthostatic hypotension s/s.
Nonpharmacologic therapy options offered.
Pharmacotherapy reviewed.
24-hour urine sodium level. Will order it. Patients with values of less than 170 mmol per 24 hours would be placed on 1 to 2 g of supplemental sodium three times a day and be reevaluated in one to two weeks, with the goal of raising urine sodium to between 150 and 200 mEq. Patients on sodium supplementation would be monitored for weight gain and edema.
References
Amazing article from the AAFP: http://www.aafp.org/afp/2011/0901/p527.html
J Am Soc Hypertens. 2013 Jul-Aug; 7(4): 317–324. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769179/