Fatigue Detectives

[Vito Andolini]

Fatigue in an otherwise healthy young man (late teens/early 20's I think). What can this be? Too much heat and humidity? He is a counselor at the local summer camp and does a good job but is just wiped out by day's end and has to nap a couple of hours. We are pleased with his work, just concerned that he might be too tired to be safe. We are thinking of sending him to the camp doctor for a Physical and some basic labs, like CBC with differential, CMP.

The other nurse and I have talked about hepatitis, HIV, cancer, anemia, chronic fatigue syndrome, Epstein-Barr. He denies GU, GI c/o, has no rashes or open lesions, except for a healing infected pimple, which is almost all cleared up. He says he's been using hot soaks and TAO. Denies exposure to any known toxins, denies allergies, says he's sleeping 8-9 hours per night. So that's infection, Endocrine (hmm, wonder if it's thyroid), GI, GU, derm. Per his pre-employment PE, his cardiorespiratory status is WNL except for a post-exertion 1st degree murmur - not sure which valve. Hmm, maybe I just got my answer, although he has no SOB, CP, edema, and even says he feels better after exercise. He says he works out in the wt room and runs 4-5 x/week! I should be doing so well. :chuckle

Has anyone seen cases like this? Diet is well-rounded, from what he tells us, but there might be some question of too many carbohydrates and too little protein. VS are normal, glucose was WNL (one time for each of these). Made us think of DM - high carbs cause release of too much insulin, which causes low sugar and hunger and craving for protein, which he says he has said craving.

[TheCommuter, BSN, RN]

My first guess would be some type of thyroid failure...

[smithtls02]

Sleep Apnea?

[kristenncrn]

Maybe I work with too many people that age, but my first guess is that he gets back up at midnight and texts his girlfriend until 0400. And he doesn't want to admit it and get in trouble.

How much does he exercise? You can sometimes hear a flow murmur with "athlete's heart".

Is he depressed? Stressed? Has he lost any weight? Does he have any pain? Swollen lymph nodes? Fever?

Did his pre-employment have lab work? Urine?

I actually thought of 1) behavioral 2) psychological 3) medical.

If it seems to be medical - I think a CBC is good. But a good exam would maybe be telling too...

I love that age - hope it turns out to be something "nothing"!!

Best of luck.

[puggy232]

You may want to screen for MS- acute fatigue, especially with heat and humidity- even though he is young not too to young for this dx kids are being dx as young as 12 or younger.

[Irish Nurse 89]

Is this a sleep away from home camp? If so, perhaps you might want to look at his sleeping patterns at night as well. Sometimes it really is hard for someone to get the proper amount of sleep that their body needs while they are away from home. I went on a cruise to Bermuda on my honeymoon, and was lucky to get about 3 hours of sleep each night, because I am one of those people that just can't sleep right when they aren't at home in their own bed.

Before going through the whole ordeal and expense of a medical work up, find out what his average sleep was like before going to this camp, and how much sleep he is getting now.