Fatigue resident survival guide

Fatigue Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Synonyms and keywords:: Weakness, Tiredness, Lethargy, Debility

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Active Malignancy

Common Causes

• Infection
• Diabetes
• Hypercalcemia
• Anemia
• Rheumatologic diseases
  • Fibromyalgia
  • Rheumatoid Arthritis
  • Polymyalgia Rheumatica
  • Systemic Lupus Erythymatosus
• Neurologic injury
• Adrenal insufficiency
• Thyroid insufficiency
• Hepatic-insufficiency
• Renal insufficiency
• Cardiopulmonary diseases
  • Congestive heart failure
  • Chronic obstructive pulmonary disease
  • Peripheral vascular disease
  • Atypical angina
• Myopathy
• Medications
  • Sedative-hypnotics
  • Analgesics
  • Antihypertensives
  • Antidepressants
  • Muscle relaxants
  • Opioids
  • Antibiotics
  • Anticancer agents (like cisplatin and Etoposide)
• Substance abuse
• Psychological Causes:
  • Depression
  • Anxiety
  • Somatization disorder
  • Dysthymic disorder
  • chronic fatigue syndrome

• Multiple sclerosis
• After malignancy treatment, patients can experience different patterns of fatigue from chemotherapy, radiation treatment, or surgery.

Diagnosis

The approach to diagnosis of fatigue is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of fatigue.

Seek proper history, ask patients to describe in their own words, what do they mean by fatigue? This will help distinguish fatigue from ❑ somnolence ❑ muscle weakness

Examine the patient: ❑ Tachypnea ❑ Cold and clammy skin ❑ Hypotension ❑ HEENT signs: Conjunctival pallor Jaundice ❑ Cardiovascular exam: Tachycardia Systolic murmur ❑ Abdominal exam: Enlarged spleen RUQ pain may indicate bilirubin gallstones ❑ Skin exam: Pallor of nail beds, palmar creases Bronze skin colour in case of repeated transfusions Leg ulcers ❑ Fever and neurological signs are seen in TTP ❑ Hemoglobinuria in some cases

Initial workup for hemolysis: ❑ Indirect bilirubin ❑ serum haptoglobin ❑ Lactate dehydrogenase level ❑ Reticulocyte count ❑ Urinalysis

Peripheral blood smear

No laboratory evidence of hemolysis

Consider differential diagnosis ❑ Iron deficiency anemia ❑ Anemia of chronic disease ❑ Vitamin B12 deficiency ❑ Folate deficiency

Degmacytes

Normal cell morphology

Spherocytes

Elliptocytes

Shistocytes

Sickle shaped cells

Hypochromic, microcytic cells

G6PD deficiency

❑ Family history ❑ Drug history ❑ Recent infections

Coomb's test

Hereditary elliptocytosis

Sickle cell disease

H/o exercise, exertion, trauma or surgery?

Beta thalassemia

Negative

Positive

No

Yes

CD55/59

❑ Drug induced hemolytic anemia ❑ Autoimmune disease

❑Exercise induced hemolysis ❑Prosthetic heart valve ❑Severe aortic stenosis

Microangiopathic hemolytic anemia

Positive

Negative

Pre-eclampsia and eclampsia

Recent diarrhea

Decreased ADAMTS13 activity

Paroxysmal nocturnal hemoglobinuria

Hereditary spherocytosis

HELLP syndrome

Hemolytic uremic syndrome

Thrombotic thrombocytopenic purpura

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

Template:WikiDoc Sources

References