FATIGUE:

Etiology: Depression (See Above), hypothyroidism, anemias, drugs (opioids), infections.

Screening: Investigations - CBC, lytes, Calcium, Creatinine, BUN, Glucose, LFT +/- TSH. Often associated with anorexia and cachexia (Anorexia-Cachexia- Asthenia)

Treatment: CNS Stimulants

- Methylphenidate 5-10mg qam and 5mg at lunch.

SOMNOLENCE

Definition: unnatural drowsiness, RR<10, decreased responsiveness

Etiology: Hypoxia, Cerebral Atrophy/ Metastases, Metabolic, Opiod excess

Treatment:

• Establish cause
• O₂ if indicated

• Narcan 0.1-0.2mg SC or IV q20min prn

MYOCLONUS

Etiology: Uremia, hepatic failure or opiod side effect

Treatment:

• reduce opiod if possible
• Lorazepam 1mg SL/PO bid - tid (if severe q4-6h)
• Diazepam 5mg PO bid - tid

FEVER

Very important to investigate (esp. in those receiving Chemo/Radio Thx) as it may cause undue pain and discomfort.

Etiology: INFECTION, drugs (Chemotherapy), thrombophlebitis (DVT). Patients must be worked up as if they are immuno-compromised.

Septic workup : CBC, CXR, Urinalysis, +/- blood, stool, sputum cultures (base your work up on associated symptoms).

Treatment: Tylenol for antipyrexia. If febrile neutropenic REFER !

Antibiotics - as per infection.