Fatigue

Question 1

Classes of medications that cause fatigue

Answer 1

B-Blockers
Antihistamines (including "non-sedating")
Sleep Aids
Narcotics
Benzos
Antidepressants 
Muscle Relaxants

Question 2

What are the initial standard recommended lab tests for fatigue?

Answer 2

CBC 
CMP
Hepatic function
ESR
Thyroid (TSH)
Hep C and HIV if not previously screened
Consider Ferritin level for women

Question 3

What are some fatigue RED FLAGS?

Answer 3

Weight loss
Night sweats
Transient neurological symtoms (weakness, vision changes, urine incontinence)
Melena

Question 4

What are pertinent inquires to elicit fatigue differentials?

Answer 4

• Sleepiness (sleep disorder, OSA)
• SOB (CHF, COPD, arrhythmias, cardiac ischemia, PE, anemia)
• Weakness (myopathies related to endocrine dysfunction or autoimmune diseases)
• Lack of energy (Depression, fibromyalgia, infectious process, malignancy, medication S/E)

Question 5

What has the IOM renamed “Chronic fatigue syndrome”?

Answer 5

“Systemic Exertion Intolerance Disease”

Question 6

What are some common exposures to lead and mercury?

Answer 6

Lead: Battery making, lead smelting, steal welding or cutting, consuming home distilled ETOH, ayurvedic medications
Mercury: fish, dental fillings, thermostats containing mercury, inhalation