Fatigue

Fatigue: Excerpt from In A Page: Pediatric Signs and Symptoms

Complaints of fatigue indicate a general state of decreased endurance for, or interest in, activities. It is typically associated with tiredness and sleepiness. Depression as a cause of fatigue in adolescents frequently goes undiagnosed.

Differential Diagnosis

• Inadequate rest
• Excessive exercise
• Insufficient caloric intake
• Depression
• Infectious mononucleosis: Common in adolescence, typically due to EBV or CMV
• Anemia
• Hepatitis
  –Viral (e.g., HAV, HBV, HCV)
  –Consider autoimmune in adolescent girls
• Drugs
  –Antihistamines, anticonvulsants, opiates
• Obesity
  –Rapid fatigue with exertion
  –Somnolence with elevated PaCO₂is termed Pickwickian syndrome
• Tonsillar-adenoidal hypertrophy
  –Impaired air exchange while sleeping
  –Associated with restless sleeping
• Chronic fatigue syndrome
  –Controversial diagnosis
  –Underlying depression is common
• Polycythemia in neonates can be associated with cyanosis and feeding problems
• Encephalitis/meningitis
• Tuberculosis
• Brucellosis: Weight loss, low-grade fever, back pain
• Hypothyroidism
• Adrenocortical insufficiency: Often with hyperpigmentation and weakness
• Hypoglycemia
• Inflammatory bowel disease
• Juvenile rheumatoid arthritis
• Systemic lupus erythematosus
• Intussusception
• Dermatomyositis: Often with muscle weakness and pain
• Congestive heart failure: With tachypnea and dyspnea on exertion
• Pericarditis: Fatigue and dyspnea may precede friction rub
• Renal tubular acidosis
• Uremia
• Myasthenia gravis
• Malignancy

Workup and Diagnosis

• History
  –Duration of complaint
  –Sleeping habits (length of sleep, restfulness, snoring)
  –Eating habits (number of meals per day, caloric intake)
  –Psychosocial stressors
  –Associated signs and symptoms (weight change, fever,
• muscle aches, breathing difficulty, diarrhea, vomiting, sore throat)
  –Medications, including over-the-counter drugs
• Physical exam
  –Vital signs and weight
  –Oral exam for tonsillar hypertrophy, exudates, erythema
  –Palpable lymph nodes
  –Hepatomegaly with tenderness
  –Splenomegaly (seen with EBV, CMV, lymphoma)
  –Skin pallor, jaundice, cyanosis
  –Increased work of breathing, wheezes, rales
  –Cardiac exam for rubs, murmurs
  –Psychological assessment of mood and affect
• Labs
  –Consider screening CBC for anemia
  –WBC differential for atypical lymphocytes (in EBV, CMV) or blasts (in leukemia)
  –Viral serology for EBV or CMV
  –ALT and AST for hepatitis
  –TSH and free T4 for hypothyroidism
  –BUN and Cr for renal dysfunction
  –Other specific testing based on history, physical exam

Treatment

• Behavioral modifications based on cause
  –Increase duration of sleep
  –Ensure three calorically adequate meals per day
• Correction of anemia
  –Iron supplementation
  –Blood transfusion if hemodynamically unstable
• Depression
  –Psychological counseling and antidepressants
• Infectious mononucleosis
  –Rest if fatigue is severe
  –No contact sports with significant splenomegaly
• Anti-inflammatory drugs for inflammatory causes
• Chronic fatigue syndrome
  –Emotional support
  –Psychological treatment if indicated
  –Modification of schedule as needed
  –Various medications have been attempted, however no clear consensus, high rate of placebo effect

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Pallor (In A Page: Pediatric Signs and Symptoms)

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• Pallor (In A Page: Pediatric Signs and Symptoms)
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• Fatigue (Handbook of Signs & Symptoms (Third Edition))

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