Symptoms for Suspecting ME/CFS NICE Guidlines
Explain to people presenting with possible symptoms of ME/CFS that there currently is no diagnostic test for ME/CFS and it is recognised on clinical grounds alone.
1.2.2Suspect ME/CFS if:
the person has had all of the persistent symptoms in box 2 for a minimum of 6 weeks in adults and 4 weeks in children and young people and
the person's ability to engage in occupational, educational, social or personal activities is significantly reduced from pre‑illness levels and
symptoms are not explained by another condition.
Symptoms for Suspecting ME/CFS
All of these symptoms should be present:
Debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.
is often delayed in onset by hours or days
is disproportionate to the activity
has a prolonged recovery time that may last hours, days, weeks or longer.
Post-exertional malaise after activity in which the worsening of symptoms:
feeling exhausted, feeling flu-like and stiff on waking
broken or shallow sleep, altered sleep pattern or hypersomnia.
Unrefreshing sleep or sleep disturbance (or both), which may include:
Cognitive difficulties (sometimes described as 'brain fog'), which may include problems finding words or numbers, difficulty in speaking, slowed responsiveness, short-term memory problems, and difficulty concentrating or multitasking.
If ME/CFS is suspected, carry out:
a medical assessment (including symptoms and history, comorbidities, overall physical and mental health)
a physical examination
an assessment of the impact of symptoms on psychological and social wellbeing
investigations to exclude other diagnoses, for example (but not limited to):
urinalysis for protein, blood and glucose
full blood count
urea and electrolytes
liver function
thyroid function
erythrocyte sedimentation rate or plasma viscosity
C-reactive protein
calcium and phosphate
HbA1c
serum ferritin
coeliac screening
creatine kinase.
Use clinical judgement to decide on additional investigations to exclude other diagnoses (for example, vitamin D, vitamin B12 and folate levels; serological tests if there is a history of infection; and 9am cortisol for adrenal insufficiency).
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