First, I can usually predict when I am going to start a controversy.  The response to this topic has totally blindsided me!

I also will challenge the commenters to read the original post carefully.  I know that orthostatic hypotension is not sensitive for mild volume contraction, but its presence increases as volume contraction worsens.

I suggested 3 indications for orthostatic evaluation:

1. GI bleeding – orthostastic changes can proceed more obvious clinical findings
2. Syncope – this is the clearest and an indisputable indication.  The finding of orthostatic hypotension often explains syncope and leads us to a diagnosis and treatment.
3. Newly increased creatinine (BUN) – especially in the hospital, we can sometimes learn that the patient really is volume contracted

There may be newer ways of assessing volume contraction.  I suspect that we will often be measuring inferior vena cava diameter as a measurement of volume status (and some of you already do this).

Nonetheless, when you really need orthostatic evaluation, I still believe it is not scut work, and actually very educational to perform this physical diagnosis maneuver at the bedside.