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General approach to treatment of fatigue in palliative care

General approach to treatment of fatigue in palliative care
Treatment of the underlying cause
Anemia - Red blood cell transfusion or an erythropoiesis-stimulating agent, most useful in patients receiving chemotherapy who have severe anemia
Deconditioning - Exercise
Dehydration - Intravenous or subcutaneous fluids
Depression - Antidepressants
Hypogonadism - Testosterone replacement therapy
Hypothyroidism - Check TSH
Hypoxia - Oxygen, if hypoxemic (eg, oxygen saturation <90% by pulse oximetry)
Infections - Antibiotics
Insomnia - Sleep hygiene, brief trial of short-acting hypnotics in refractory cases
Metabolic and endocrine disorders - Correction of disorder (eg, thyroid or testosterone replacement)
Pain - NSAIDs, opioids
Treatment of the symptom
Established therapies - Glucocorticoids, megestrol acetate
Less well-established therapies - Methylphenidate, modafinil, American ginseng
Alternative therapies - Melatonin, fish oil, yoga, and meditation
TSH: thyroid-stimulating hormone; NSAIDs: nonsteroidal antiinflammatory drugs.
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