| Evaluating Fatigue
Generalized fatigue has many possible causes (TABLE 3) that should be ruled out with screening tests (TABLE 4).
Since sleep disorders are common in polio survivors,9,10 referral to a sleep clinic should be considered. In our practice, we often see patients who feel tired but say they have no trouble sleeping. However, many of them test positive for sleep disturbances, including obstructive sleep apnea (characterized by morning fatigue, snoring, and difficulty sleeping supine) and random limb movement disorder (characterized by morning muscle pain and overall fatigue).
Depression, thyroid dysfunction, or both may be present as coexisting conditions and also contribute to fatigue.
TABLE 3
Differential diagnosis for fatigue
Common Causes
- Anemia
- Chronic pain
- Excessive exercise or muscular overexertion
- Heart disease
- Hypothyroidism
- Respiratory insufficiency
- Sleep disorders
- Depression
- Overdose or side effects of prescribed medication
- Generalized deconditioning
Uncommon Causes
- Anxiety
- Cancer and side effects of cancer treatment
- Chronic endocrinologic illness (eg. Diabetes)
- Chronic fatigue syndrome
- Chronic infection
- Chronic rheumatologic illnesses (eg.Rheumatoid arthritis)
- Fibromyalgia
- Illicit drug or alcohol dependency
- Postviral infection
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TABLE 4
Screening Tests for Fatigue
Laboratory Blood Tests
- Complete blood count
- Erythrocyte sedimentation rate
- Creatinine and urea nitrogen
- Glucose
- Calcium and phosphorus
- Electrolytes
- Albumin and total protein
- Liver function tests
- Thyroid function tests
- Rheumatology screen
- C-reative protein
- Serologic tests (eg, for Borrelia burgdorferi [Lyme disease] human immunodeficiency virus)
Other Tests
- Urinalysis
- Chest radiography
- Electrocardiography
- Sleep study
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