Chronic Fatigue Flashcards
Key Issue on Fatigue Complaints
Careful history to differentiate from sleepiness, weakness, dyspnea, excess daytime sleepiness
Rule out common causes such as sleep apnea, anemia, use of substances or medications, stress, infection
Organ-based fatigue
patients with organ-based medical illness often associated their fatigue with activities they are unable to complete. By contrast, patients with fatigue that is not organ-based are tired all the time and their fatigue is not necessarily related to exertion nor improved with rest.
Fatigue Diagnostics
CBC to rule out anemia
TSH to rule out hypothyroid
ESR/CRP to rule out infection/inflammation
Cortisol/ACTH to rule out adrenal insufficiency
HIV/TB/Hepatitis Panel to rule out infectious disease
Fecal occult blood test
Chest x-ray
Top fatigue causes
Anemia
Malignancy
Somatic Disease
Psychiatric illness
Post-Polio Syndrome
Symptoms of postpolio syndrome arise four to five decades after initial infection and may lead to muscle weakness and atrophy in previously affected muscle groups, pain, and fatigue. Fortunately, polio has been nearly eradicated worldwide since the introduction and refinements of vaccines developed in the 1950s
Fibromyalgia
Fatigue usually also has cognitive symptoms, joint or tendon pain
Chronic Fatigue Diagnosis
50% decrease in activity level is suggestive
Criteria:
- Marked, rapid physical or cognitive fragility in response to exertion
- Neurological impairments
- Immune GI/GU impairments
- Energy production/transport impairment
Postpartum women with fatigue
Anemia, thyroid, endocrine, UTI screening first!
Chronic Fatigue Management
Graduated exercise and cognitive behavior therapy
Always consider sleep issues (refer to sleep center if suspected)
Diary of fatigue issues and times may be helpful to diagnosis contributing factors
What is the most likely underlying cause of chronic fatigue symptoms in a patient with poorly controlled diabetes mellitus (DM)?
Decreased metabolism
Psychological stress
Sleep apnea
Calorie depletion
Patients with poorly controlled DM have significant fluid and calorie depletion, causing fatigue.
