Fatigue resident survival guide (pediatrics): Difference between revisions
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*'''[[Depression]]''' should be treated with appropriate [[anti-depressants]] such as [[amitriptyline]] or [[fluoxetine]] at a low dose of 10-20mg at bedtime. <ref name="Mendelson Tandon 2016 pp. 201–218">{{cite journal | last=Mendelson | first=Tamar | last2=Tandon | first2=S. Darius | title=Prevention of Depression in Childhood and Adolescence | journal=Child and adolescent psychiatric clinics of North America | publisher=Elsevier BV | volume=25 | issue=2 | year=2016 | issn=1056-4993 | pmid=26980124 | doi=10.1016/j.chc.2015.11.005 | pages=201–218}}</ref> | *'''[[Depression]]''' should be treated with appropriate [[anti-depressants]] such as [[amitriptyline]] or [[fluoxetine]] at a low dose of 10-20mg at bedtime. <ref name="Mendelson Tandon 2016 pp. 201–218">{{cite journal | last=Mendelson | first=Tamar | last2=Tandon | first2=S. Darius | title=Prevention of Depression in Childhood and Adolescence | journal=Child and adolescent psychiatric clinics of North America | publisher=Elsevier BV | volume=25 | issue=2 | year=2016 | issn=1056-4993 | pmid=26980124 | doi=10.1016/j.chc.2015.11.005 | pages=201–218}}</ref> | ||
*[[Orthostatic hypotension]] should be treated with intravascular fluids (at least 2L/day).<ref name="Stewart Boris Chelimsky Fischer 2018 p=e20171673">{{cite journal | last=Stewart | first=Julian M. | last2=Boris | first2=Jeffrey R. | last3=Chelimsky | first3=Gisela | last4=Fischer | first4=Phillip R. | last5=Fortunato | first5=John E. | last6=Grubb | first6=Blair P. | last7=Heyer | first7=Geoffrey L. | last8=Jarjour | first8=Imad T. | last9=Medow | first9=Marvin S. | last10=Numan | first10=Mohammed T. | last11=Pianosi | first11=Paolo T. | last12=Singer | first12=Wolfgang | last13=Tarbell | first13=Sally | last14=Chelimsky | first14=Thomas C. | title=Pediatric Disorders of Orthostatic Intolerance | journal=Pediatrics | publisher=American Academy of Pediatrics (AAP) | volume=141 | issue=1 | date=2017-12-08 | year=2018 | issn=0031-4005 | pmid=29222399 | pmc=5744271 | doi=10.1542/peds.2017-1673 | page=e20171673}}</ref> | *[[Orthostatic hypotension]] should be treated with intravascular fluids (at least 2L/day).<ref name="Stewart Boris Chelimsky Fischer 2018 p=e20171673">{{cite journal | last=Stewart | first=Julian M. | last2=Boris | first2=Jeffrey R. | last3=Chelimsky | first3=Gisela | last4=Fischer | first4=Phillip R. | last5=Fortunato | first5=John E. | last6=Grubb | first6=Blair P. | last7=Heyer | first7=Geoffrey L. | last8=Jarjour | first8=Imad T. | last9=Medow | first9=Marvin S. | last10=Numan | first10=Mohammed T. | last11=Pianosi | first11=Paolo T. | last12=Singer | first12=Wolfgang | last13=Tarbell | first13=Sally | last14=Chelimsky | first14=Thomas C. | title=Pediatric Disorders of Orthostatic Intolerance | journal=Pediatrics | publisher=American Academy of Pediatrics (AAP) | volume=141 | issue=1 | date=2017-12-08 | year=2018 | issn=0031-4005 | pmid=29222399 | pmc=5744271 | doi=10.1542/peds.2017-1673 | page=e20171673}}</ref> | ||
* '''Cancer-related fatigue''' is usually treated with the following interventions : <ref name="Escalante Manzullo 2009 pp. 412–416">{{cite journal | last=Escalante | first=Carmen P. | last2=Manzullo | first2=Ellen F. | title=Cancer-Related Fatigue: The Approach and Treatment | journal=Journal of general internal medicine | publisher=Springer Science and Business Media LLC | volume=24 | issue=S2 | date=2009-10-18 | issn=0884-8734 | pmid=19838841 | pmc=2763160 | doi=10.1007/s11606-009-1056-z | pages=412–416}}</ref> | * '''Cancer-related fatigue''' is usually treated with the following interventions : <ref name="Escalante Manzullo 2009 pp. 412–416">{{cite journal | last=Escalante | first=Carmen P. | last2=Manzullo | first2=Ellen F. | title=Cancer-Related Fatigue: The Approach and Treatment | journal=Journal of general internal medicine | publisher=Springer Science and Business Media LLC | volume=24 | issue=S2 | date=2009-10-18 | issn=0884-8734 | pmid=19838841 | pmc=2763160 | doi=10.1007/s11606-009-1056-z | pages=412–416}}</ref><br> | ||
❑Exercise plus leisure activities | ❑Exercise plus leisure activities | ||
❑Exercise plus psychosocial intervention | ❑Exercise plus psychosocial intervention |
Revision as of 15:56, 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 |
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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 |
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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
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Physical Exam
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Diagnostic Tests
Basic Screening Tests
Additional Tests ❑Indicated if fatigue persists, diagnosis remains uncertain, or symptoms of neurally mediated hypotension are present
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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
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❑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.