• Ryan M Antiel, Jonathan S Caudill, Barbara E U Burkhardt, Chad K Brands, and Philip R Fischer.
• Department of Pediatric & Adolescent Medicine, Division of General Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA. antiel.ryan@mayo.edu
• South. Med. J. 2011 Aug 1; 104 (8): 609-11.

ObjectivesMore than 10% of adolescents suffer from severe fatigue and/or orthostatic intolerance. Adult studies show correlations between iron insufficiency and fatigue as well as between hypovitaminosis D and non-specific pain. We sought to determine whether there were correlations between nutritional factors (iron status, and serum vitamin D levels) and chronic ill health.MethodsWe reviewed records of 188 adolescents with symptoms of fatigue and/or orthostatic intolerance and who underwent autonomic reflex screening.ResultsOf the 188 patients, 130 patients (69%) had excessive postural tachycardia (PT) with a heart rate (HR) change of ≥30 bpm. 62 patients (47%, n = 131) had iron insufficiency with low iron stores, and 29 patients (22%, n = 131) were iron deficient. HR change did not correlate to ferritin level (P = 0.15). 21 patients (22%, n = 95) had hypovitaminosis D (25-hydroxyvitamin D ≤20 ng/mL). There was a significant association with hypovitaminosis D and orthostatic intolerance (P = 0.024).ConclusionIn patients presenting with chronic fatigue and/or orthostatic intolerance, low ferritin levels and hypovitaminosis D are common, especially in patients with PT.

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