A 32-year-old woman, 3 weeks postpartum after an uncomplicated vaginal delivery, comes to the clinic with 2 weeks of lightheadedness on standing. This morning she briefly lost consciousness after getting out of bed and recovered within 30 seconds, with no confusion, tongue biting, or incontinence. She has no chest pain or palpitations, is not breastfeeding, and takes no medication other than acetaminophen. The neurologic and cardiac examinations, electrolytes, ECG, and echocardiogram are normal, and hemoglobin is 124 g/L (115-155). Blood pressure and heart rate are measured supine and again after 3 minutes of standing.
| Heart rate | 72/min supine; 102/min standing at 3 minutes |
| Respiratory rate | 14/min |
| Temperature | 36.8 °C |
| O2 saturation | 99%, room air |
| Blood pressure | 118/74 mm Hg supine; 92/60 mm Hg standing at 3 minutes |
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Which of the following are the most appropriate initial recommendations?
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