Patient discussions

Advise all patients to:

  • Avoid exposure to extreme heat, prolonged standing, medications that exacerbate intravascular depletion (e.g., diuretics) or sinus and orthostatic tachycardia (e.g., noradrenaline reuptake inhibitors such as atomoxetine), afterload reduction medications (e.g., ACE inhibitors, angiotensin-II receptor antagonists), excessive alcohol and exercise, and recreational drugs (e.g., cocaine, methamphetamines).[1][2][4]​​[60]​

  • Drink at least 2 to 3 litres of water per day.[1][2]

  • Increase their salt intake up to 10 g per day (1 teaspoon of salt is approximately equivalent to 2.3 g).[1][2][4][58]​​​​ However, in practice, increased salt intake is an inappropriate treatment for certain patients, such as those with hypertension, or kidney or cardiovascular disease.

  • Use waist-high compression stockings and/or an abdominal binder to reduce venous pooling in their lower extremities and splanchnic circulation.[1][2][59]​​​​

  • Undertake graded exercise training, starting with supine progressive aerobic and leg resistance training then progressing to upright exercises.[1][2]​​​​​​[4]​

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