Gen Med

#Fatigue

acute is <1mo, subacute 1-6 mo, chronic >6mo

Causes:

Lifestyle: alcohol, chemical dependence, extremes of activity, frequent travel (jet lag), night shift work, work/life imbalance

Medical: anemia, cancer, CKD, chronic liver disease, chronic lung disease, heart failure, HIV/AIDs, hyperglycemia, obesity, thyroid disorders

Medication side effects: antidepressants, antihistamines, antipsychotics, benzodiazepines, beta blockers, opioids

Psychological: anxiety, depression, stress

Sleep: poor sleep habits, restless leg syndrome, sleep apnea, sleep deprivation

Workup: cbc, CMP, tsh, GAD7, PHQ9

#systemic exertion intolerance disease (SEID)

Diagnosis of SEID requires the presence of all of the following three symptoms:

A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest

Postexertional malaise

Unrefreshing sleep

In addition, the patient must have at least one of the following two manifestations:

Cognitive impairment

Orthostatic intolerance (symptoms such as lightheadedness, dizziness, and headache that worsen with upright posture and improve with recumbency)