A 35-year- old woman diagnosed as having chronic fatigue syndrome 1 year previously presents with spells of lightheadedness and palpitations during the day. Symptoms are most notable with changing from a seated or supine position to standing. PME: She has no other symptoms but recalls that she had an upper respiratory tract infection a few weeks previously, which she treated with over-the- counter agents. Vital Stats: She has an office-based blood pressure of 124/85 mm Hg (lying), 120/80 mm Hg (sitting), and 114/78 mm Hg (standing) and an office-based heart rate of 90 beats/min (lying), 102 beats/min (sitting), and 120 beats/min (standing).
Her urine sodium excretion rate is 140 mmol/24 h. Additional studies confirm the diagnosis and have excluded the neuropathic variant; however, the patient continues to have symptoms despite initial recommendations. What would be the next step in the…
