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Orthostatic Hypotension

Orthostatic hypotension can occur when a patient is rapidly moved from a supine to an upright position.

This condition occurs most commonly in the elderly, in pregnant women and patients taking medications, such as:

  • diuretics
  • β-adrenergic blockers
  • other anti-hypertensives (including vasodilators)
  • nitroglycerin

Signs and symptoms#

  • pallor
  • profuse sweating (diaphoresis)
  • brief episode of syncope
  • feeling of distress
  • dizziness
  • nausea
  • moist and cold extremities
  • hypotension


  • place the patient in the Trendelenburg position (lef lateral decubitus for pregnant women)
  • administer supplemental oxygen, 6-8 L/min by nasal cannula or mask
  • use spirits of ammonia
  • place a cold towel on the patient’s forehead
  • monitor blood pressure, pulse, and respiratory rate
  • if patient is bradycardic (pulse rate <60 beats/minute), administer atropine 0.5mg IV or 1mg IM every 5 minutes until max dose of 3 mg
  • if hypotension is persistent, administer IV fluids
  • arrange for home escort
  • notify the patient’s primary care provider
  • call later to check on patient


Vagal stimulation of the parasympathetic tone (bradycardia and vasodilation) and from diminished sympathetic tone.