Fatigue resident survival guide (pediatrics): Difference between revisions
Sara Mohsin (talk | contribs) (→Do's) |
Sara Mohsin (talk | contribs) |
||
Line 111: | Line 111: | ||
{{familytree | | | | | | | | | | | | | |!| | | | | | }} | {{familytree | | | | | | | | | | | | | |!| | | | | | }} | ||
{{familytree | | | | | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 30em; padding:1em;">'''Physical Exam <br> | {{familytree | | | | | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 30em; padding:1em;">'''Physical Exam <br> | ||
* '''[[Temperature]]''' - Any recurrent or persistent fever should be documented. | * '''[[Temperature]]''' - Any recurrent or persistent [[fever]] should be documented. | ||
* '''[[Pulse]]''': [[Anxiety]] and [[stress]] can be the most common causes of elevated [[pulse rate]] in the pediatrician office. | * '''[[Pulse]]''': [[Anxiety]] and [[stress]] can be the most common causes of elevated [[pulse rate]] in the pediatrician office. | ||
*'''[[Respiratory |Respiratory Rate]]''': Abnormalities in respiratory rate can also be associated with cardiac, metabolic, or pulmonary disorders. Variation may also indicate [[drug abuse]] among the adolescent population | *'''[[Respiratory |Respiratory Rate]]''': Abnormalities in [[respiratory rate]] can also be associated with [[cardiac]], [[metabolic]], or [[pulmonary]] [[disorders]]. Variation may also indicate [[drug abuse]] among the [[adolescent]] [[population]]. | ||
* '''[[Blood Pressure]]''': Elevated | * '''[[Blood Pressure]]''': Elevated [[blood pressure]] may be due to [[metabolic]] conditions such as [[cushing syndrome]], [[hyperaldosteronism]], [[hyperthyroidism]], and [[renal]] abnormalities. [[Orthostatic hypotension]] may also be associated with unexplained [[fatigue]]. | ||
*'''[[Height]]''': Failure of reaching exponential [[height]] during growth years might hint at the possibility of an underlying disorder. | *'''[[Height]]''': Failure of reaching exponential [[height]] during [[growth]] years might hint at the possibility of an underlying [[disorder]]. | ||
*'''[[Weight]]''': Excessive weight gain or weight loss over time may also indicate a serious underlying systemic process. | *'''[[Weight]]''': Excessive [[weight gain]] or [[weight loss]] over time may also indicate a serious underlying [[systemic]] process. | ||
*'''[[Dermatological lesions|Cutaneous signs]]''': [[Cyanosis]], [[pallor]] or generalized [[hyperpigmentation]] may be seen in | *'''[[Dermatological lesions|Cutaneous signs]]''': [[Cyanosis]], [[pallor]] or generalized [[hyperpigmentation]] may be seen in congenital cardiac disorders, [[iron deficiency anemia]], and [[Addison disease]] respectively. | ||
*'''Ocular & Oral Examination''': The presence of [[dry eyes]], allergic shiners, bluish discoloration under the eyes, may hint towards [[ | *'''[[Ocular]] & [[Oral]] Examination''': The presence of [[dry eyes]], [[allergic shiners]], bluish discoloration under the [[eyes]], may hint towards [[sjogren syndrome]], [[chronic sinusitis]] respectively. [[Oral]] findings may help to rule out [[bulimia]], [[Addison disease]] (hyperpigmentation of gum), and other [[systemic]] disorders. | ||
*'''Musculoskeletal Signs''': Muscular weakness and fatigue can also be associated with [[muscular dystrophy]], [[myasthenia gravis]], and [[juvenile rheumatoid arthritis]]. Chronic bone pain and fatigue might indicate [[malignancy]]. | *'''[[Musculoskeletal]] Signs''': [[Muscular weakness]] and [[fatigue]] can also be associated with [[muscular dystrophy]], [[myasthenia gravis]], and [[juvenile rheumatoid arthritis]]. Chronic [[bone pain]] and [[fatigue]] might indicate [[malignancy]]. | ||
* '''Neurological Signs''' : Chiari Malformation may be associated with neurological signs. Floppy palatal tissue might indicate [[obstructive sleep apnea]].<br> </div> }} | * '''[[Neurological]] Signs''' : Chiari Malformation may be associated with [[neurological]] signs. Floppy [[palatal]] [[tissue]] might indicate [[obstructive sleep apnea]].<br> </div> }} | ||
{{familytree | | | | | | | | | | | | | |!| | | | | | }} | {{familytree | | | | | | | | | | | | | |!| | | | | | }} | ||
{{familytree | | | | | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 30em; padding:1em;">'''Diagnostic Tests''' | {{familytree | | | | | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 30em; padding:1em;">'''Diagnostic Tests''' |
Revision as of 15:52, 9 October 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]
Synonyms and keywords: Fatigue, Pediatric Fatigue, Approach to weakness, Approach to tiredness, Approach to lethargy, Approach to debility
Fatigue resident survival guide (pediatrics) Microchapters |
---|
Overview |
Causes |
Diagnosis |
Treatment |
Do's |
Don'ts |
Overview
Fatigue in chronic health conditions in childhood is pretty common and has been associated with poor quality of life. Fatigue, a subjective feeling of exhaustion is a state of being less active. It is usually a benign condition. Fatigue and weakness, both being ubiquitous complaints are sometimes difficult to define. Fatigue involves extreme and unusual tiredness with decreased performance and sometimes irritability. The differential diagnosis of fatigue in pediatrics is huge and encompasses different underlying systemic disorders. Emergent evaluation and treatment of fatigue is rarely required except in some selected conditions. Both non-pharmacological and pharmacological treatment options are utilized in the treatment of fatigue.
Causes
- The causes of fatigue in the pediatric population are enormous but can be divided mainly into the following categories:[1][2]
General Causes | Behavorial/Psychological | Infections | Medication Induced | Metabolic | Chronic Conditions |
---|---|---|---|---|---|
|
|
Complete Diagnostic Approach
- A complete diagnostic approach should be carried out after proper evaluation and following the initiation of any urgent intervention:[3][4]
History
| |||||||||||||||||||||||||||||||||||||||||
Physical Exam
| |||||||||||||||||||||||||||||||||||||||||
Diagnostic Tests
Basic Screening Tests
Additional Tests ❑Indicated if fatigue persists, diagnosis remains uncertain, or symptoms of neurally mediated hypotension are present
| |||||||||||||||||||||||||||||||||||||||||
Cause Identified | |||||||||||||||||||||||||||||||||||||||||
YES | NO | ||||||||||||||||||||||||||||||||||||||||
Manage Accordingly | Unexplained Fatigue | ||||||||||||||||||||||||||||||||||||||||
Pyscological Component likely? | |||||||||||||||||||||||||||||||||||||||||
❑Lifestyle advice as appropriate ❑Behavorial Changes ❑Rule out and manage according to the Psychological cause | |||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of fatigue in children and adolescent population.
Treatment should be according to the cause of fatigue and should meet individual patient's requirements. | |||||||||||||||||||||||||||||||||||||||||||
Non-Pharmacological Treatment | Pharmacological Treatment | ||||||||||||||||||||||||||||||||||||||||||
Advice to the adolescent and teenager that get less sleep. •Reduce the TV watching hours especially at bedtime
|
❑Exercise plus leisure activities ❑Exercise plus psychosocial intervention ❑Healing touch ❑Massage ❑Acupressure
Fluids: Fluids and electrolytes – Give a bolus of D5 normal saline (5% dextrose with 0.9% saline, without potassium), 20 mL/kg intravenously over one hour. | ||||||||||||||||||||||||||||||||||||||||||
Do's
- Most of the cases of fatigue don't require emergency management.
- In case of congenital cardiac causes, fatigue may develop as a result of heart failure and hemodynamically unstable patients require urgent direct-current cardioversion.
- Endocrine disorders: Diabetic ketoacidosis or nonketotic hyperglycemic states and Addison's crisis require urgent correction of blood sugar levels, acidosis, electrolyte & fluid imbalances.[11][12]
- Infectious disease requires urgent antibiotics and evaluation.
- Order all the relevant labs and investigations in case of unresolved fatigue.
- Orthostatic hypotension may require urgent intravascular fluids.
Don'ts
- Sedating drugs should be avoided in infectious causes of fatigue.
- Dehydration should be avoided in the patient with the history of orthostatic hypotension.[7]
References
- ↑ Findlay, Sheri M (2008). "The tired teen: A review of the assessment and management of the adolescent with sleepiness and fatigue". Paediatrics & child health. Oxford University Press (OUP). 13 (1): 37–42. doi:10.1093/pch/13.1.37. ISSN 1205-7088. PMC 2528817. PMID 19119351.
- ↑ Silva, Michele Cristina Miyauti da; Lopes Júnior, Luís Carlos; Nascimento, Lucila Castanheira; Lima, Regina Aparecida Garcia de (2016-08-29). "Fatigue in children and adolescents with cancer from the perspective of health professionals". Revista latino-americana de enfermagem. FapUNIFESP (SciELO). 24 (0). doi:10.1590/1518-8345.1159.2784. ISSN 0104-1169. PMC 5016058. PMID 27579937.
- ↑ Millman, R. P. (2005-06-01). "Excessive Sleepiness in Adolescents and Young Adults: Causes, Consequences, and Treatment Strategies". Pediatrics. American Academy of Pediatrics (AAP). 115 (6): 1774–1786. doi:10.1542/peds.2005-0772. ISSN 0031-4005. PMID 15930245.
- ↑ Bansal, Amolak S (2016-07-19). "Investigating unexplained fatigue in general practice with a particular focus on CFS/ME". BMC Family Practice. Springer Science and Business Media LLC. 17 (1). doi:10.1186/s12875-016-0493-0. ISSN 1471-2296. PMC 4950776. PMID 27436349.
- ↑ 5.0 5.1 Meltzer, Lisa J.; Mindell, Jodi A. (2006). "Sleep and Sleep Disorders in Children and Adolescents". The Psychiatric clinics of North America. Elsevier BV. 29 (4): 1059–1076. doi:10.1016/j.psc.2006.08.004. ISSN 0193-953X. PMID 17118282.
- ↑ Mendelson, Tamar; Tandon, S. Darius (2016). "Prevention of Depression in Childhood and Adolescence". Child and adolescent psychiatric clinics of North America. Elsevier BV. 25 (2): 201–218. doi:10.1016/j.chc.2015.11.005. ISSN 1056-4993. PMID 26980124.
- ↑ 7.0 7.1 Stewart, Julian M.; Boris, Jeffrey R.; Chelimsky, Gisela; Fischer, Phillip R.; Fortunato, John E.; Grubb, Blair P.; Heyer, Geoffrey L.; Jarjour, Imad T.; Medow, Marvin S.; Numan, Mohammed T.; Pianosi, Paolo T.; Singer, Wolfgang; Tarbell, Sally; Chelimsky, Thomas C. (2017-12-08). "Pediatric Disorders of Orthostatic Intolerance". Pediatrics. American Academy of Pediatrics (AAP). 141 (1): e20171673. doi:10.1542/peds.2017-1673. ISSN 0031-4005. PMC 5744271. PMID 29222399. Check date values in:
|year= / |date= mismatch
(help) - ↑ Escalante, Carmen P.; Manzullo, Ellen F. (2009-10-18). "Cancer-Related Fatigue: The Approach and Treatment". Journal of general internal medicine. Springer Science and Business Media LLC. 24 (S2): 412–416. doi:10.1007/s11606-009-1056-z. ISSN 0884-8734. PMC 2763160. PMID 19838841.
- ↑ Nap-van der Vlist, Merel M; Dalmeijer, Geertje W; Grootenhuis, Martha A; van der Ent, Cornelis K; van den Heuvel-Eibrink, Marry M; Wulffraat, Nico M; Swart, Joost F; van Litsenburg, Raphaële R L; van de Putte, Elise M; Nijhof, Sanne L (2019-06-07). "Fatigue in childhood chronic disease". Archives of disease in childhood. BMJ. 104 (11): 1090–1095. doi:10.1136/archdischild-2019-316782. ISSN 0003-9888. PMID 31175124.
- ↑ Lopes, Clarice L.S.; Pinheiro, Paula Pitta; Barberena, Luzia S.; Eckert, Guilherme U. (2017). "Diabetic ketoacidosis in a pediatric intensive care unit". Jornal de pediatria. Elsevier BV. 93 (2): 179–184. doi:10.1016/j.jped.2016.05.008. ISSN 0021-7557. PMID 27770618.
- ↑ 11.0 11.1 Uçar, Ahmet; Baş, Firdevs; Saka, Nurçin (2016-04-08). "Diagnosis and management of pediatric adrenal insufficiency". World journal of pediatrics : WJP. Springer Science and Business Media LLC. 12 (3): 261–274. doi:10.1007/s12519-016-0018-x. ISSN 1708-8569. PMID 27059746.
- ↑ Gildas, Aymar Pierre; Zaharo, Fayçal Khalil; Missambou Mandilou, Steve Vassili; Kambourou, Judicaël; Letitia, Lombet; Yolaine Poathy, Jesse Pierre; Engoba, Moyen; Cyriaque Ndjobo, Mamadou Ildevert; Monabeka, Henri Germain; Moyen, Georges Marius (2018). "Acidocétose diabétique chez l'enfant: aspects épidémiologiques et pronostiques". The Pan African medical journal. Pan African Medical Journal. 31. doi:10.11604/pamj.2018.31.167.14415. ISSN 1937-8688. PMC 6488241. PMID 31086620.