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: Mounika Lakhmalla, MBBS[2]Tayyaba Ali, M.D.[3]

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

Overview

Fatigue is a common nonspecific symptom due to a wide range of etiologies.Patients often use this term to describe a range of issues like difficulty initiating activity ; decreased capacity to maintain activity ; Trouble with concentration, memory, and emotional stability; or sleepiness or an uncontrollable need to sleep. The term fatigue can sometimes be used synonymously with Tiredness. Fatigue can present alone as a primary symptom or in association with other localizing symptoms.

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
  • Sjögren's syndrome
• Neurologic injury
• Endocrine Causes:
  • Adrenal insufficiency
  • Thyroid insufficiency
  • Hyperthyroidism
  • Electrolyte abnormalities
• Hepatic-insufficiency
• Renal insufficiency
• Cardiopulmonary diseases
  • Congestive heart failure
  • Chronic obstructive pulmonary disease
  • Peripheral vascular disease
  • Atypical angina
  • Obstructive sleep apnea.
• Myopathy
• Medications & Substance abuse
  • Sedative-hypnotics
  • Analgesics
  • Antihypertensives
  • Antidepressants
  • Muscle relaxants
  • Opioids
  • Antibiotics
  • Alcohol
  • Marijuana
  • Cocaine/other stimulants
  • Anticancer agents (like cisplatin and Etoposide)
• 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.

• Diagnostic evaluation of fatigue when it presents as a predominant symptom includes a detailed history and physical examination, basic laboratory studies, and updated cancer screening interventions.
• Additional diagnostic testing depends on associated localized findings.
• Extensive laboratory studies with out a suggestive history or physical exam findings is of limited diagnostic utility while evaluating chronic 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

The history should also determine the characteristics, severity, and temporal pattern of fatigue: ❑ Onset – Abrupt or gradual, relationship to illness or life event ❑ Course – Stable, improving, or worsening ❑ Duration and daily pattern ❑ Factors that alleviate or exacerbate it ❑ Impact on daily life – Ability to work, socialize, participate in family activities ❑ Accommodations that the patient/family has had to make to deal with symptom

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

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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