Tiredness/fatigue

Question 1

What are the key facts about tiredness?

Answer 1

• It is interchangeable with terms such as loss of energy, weariness, exhaustion and listlessness
• Commonest cause is psychological distress
• An important cause of day time tiredness is OSA
• Underlying disorders include anaemia, endocrine, metabolic, cardiac, chronic infection, autoimmune, psychiatric and malignancy
• Chronic tiredness typically lasts >2 weeks

Question 2

What is the safety diagnostic model for tiredness?

Answer 2

Probablity diagnosis-

• Stress/anxiety/depression
• Postviral infection
• Sleep apnoea

Serious disorders not to be missed-

• Malignant disease
• Cardiac arrhythmias/cardiomyopathy
• Anaemia
• Haemovchromatosis
• HIV/Hep C

Pitfalls-

• Coeliac disease
• Food intolerance
• Masked depression
• Chronic fatigue syndrome
• Alcohol/withdrawal
• Menopause syndrome
• Pregnancy
• Kidney failure
• Hypokalemia
• Lack of fitness

Seven masquerades checklist-

• Depression
• Diabetes
• Drugs (alcohol, antihypertensives, antidepressants, corticosteroids,OCP,NSAIDS)
• Anaemia
• Thyroid disease
• Spinal dysfunction
• UTI

Question 3

What are the red flag pointers for tiredness

Answer 3

• Unexplained weight loss
• Persistent fevers
• Symptoms of depression
• Drug and alcohol abuse
• Sleep disturbance

Question 4

What are the key features in history for tiredness?

Answer 4

• Sleep pattern including difficulty initiating sleep, middle insomnia and early morning awakening
• Energy-performance-ability to cope
• Weight changes
• Sexual activity/problems
• Suicidal ideas
• OTC drugs/recreational drugs/alcohol
• Aggravating factors such as medication/trauma/infection/breavement/stress
• Psychological history such as stress/anxiety/phobias

Question 5

What are the baseline Ix for tiredness?

Answer 5

• FBC and film
• ESR/CRP
• TFT
• LFT
• UEC/RFT
• Fasting BSL
• Iron studies
• Midstream Urine culture and microscopy
• Sleep study if any symptoms
• Management depends on underlying cause