Orthostatic intolerance

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Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Orthostatic intolerance
• Positional symptoms, hydration, meals, sleep, activity, medications, and associated symptoms reviewed
• No fainting during exercise, fainting without warning, chest pain with exercise, family history of early sudden cardiac death, or restrictive eating
• Cardiac and neurologic exam reassuring
• ECG normal
• Recommended at least 64-80 ounces of water spread through the day
• Recommended extra salt in the diet
• Recommended a graded exercise program, starting with recumbent exercise such as swimming, rowing, or a recumbent bike
• Recommended regular meals and snacks, consistent sleep, and limiting caffeine
• Follow up in 4-6 weeks to recheck symptoms, school attendance, and activity

Feeling lightheaded or unwell on standing is common in teens and usually improves with more water and salt, regular meals, good sleep, and gradually building up exercise. Recommended supportive care with an emphasis on carrying a water bottle, sitting or lying down at the first warning signs, and staying in school and active as much as possible. Return precautions given including fainting, especially with exercise, chest pain, a racing heartbeat at rest, trouble breathing, an injury from a fall, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

POTS vs orthostatic hypotension (title)
Symptoms (lightheaded, racing on standing, fatigue, brain fog, headaches, nausea, exercise intolerance, mornings, post-viral)
Red flags present or absent (exertional or sudden fainting, exertional chest pain, family history, restrictive eating)
Active stand test with thresholds
ECG; CBC, ferritin, TSH, vitamin D, CMP
Hydration, salt, gradual conditioning
Compression, head of bed, school plan, PT
Cardiology, neurology, adolescent medicine

Return precautions in the template

faintingespecially with exercisechest paina racing heartbeat at resttrouble breathingan injury from a fall

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.