Thursday, 7 July 2016

Approach to tiredness/fatigue

Tiredness/chronic fatigue: diagnostic strategy model

Probability diagnosis

  • Stress and anxiety
  • Depression
  • Viral/postviral infection 
  • Sleep-related disorder (e.g. sleep apnoea)
Serious disorders not to be missed
  • malignant disease
  • cardiac arrhythmia (e.g. sick sinus syndrome)
  • cardiomyopathy
  • anaemia 
  • hidden abscess
  • haemochromatosis
  • HIV infections 
  • Hepatitis C
Pitfalls
  • 'Masked' depression
  • Food intolerance
  • Coeliac disease
  • Chronic infection (e.g. lyme disease)
  • Incipient CCF
  • Fibromyalgia
  • Lack of fitness
  • Drugs: alcohol, prescribed, withdrawal
  • Menopause syndrome
  • Pregnancy
  • Neurological disorders
    • post-head injury
    • CVA
    • Parkinson disease
  • Kidney failure
  • Metabolic (e.g. hypokalaemia, hypomagnesaemia)
  • Chemical exposure (e.g. occupational)
  • Rarities
    • Hyperparathyroidism
    • Addison disease
    • Cushing syndrome
    • Narcolepsy
    • Multiple sclerosis
    • Autoimmune disorders
Minimal investigations from John Murtagh General practice 5th edition:
  • FBE
  • ESR/CRP
  • TFTs
  • Coeliac serology
  • LFT
  • CMP
  • BSLs
  • Iron studies
  • Urine MCS

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