Interactive diabetes case 20: A 76-year-old patient with longstanding type 2 diabetes, orthostatic hypotension, and recurrent syncope – A2

ANSWER — 

Incorrect.

It is essential to determine whether the signs and symptoms of orthostatic hypotension are caused or exacerbated by volume depletion or a medication. Volume depletion may be due to suboptimal glycemic management, a diuretic agent, or another cause. Offending medications include antihypertensive agents, tricyclic agents, some selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, dopamine agonists, and alpha-receptor blockers such as those that are used for the treatment of bladder outlet obstruction. If one or more of these factors is causal or contributory, then the likelihood that any pharmacologic intervention will be successful is reduced, and the situation will be confounded.

Fludrocortisone and high salt intake are appropriate interventions once volume depletion, a medication, or other causes of orthostatic hypotension have been excluded.

Return to the beginning to try again. (See "Interactive diabetes case 20: A 76-year-old patient with longstanding type 2 diabetes, orthostatic hypotension, and recurrent syncope".)