Table II.

The TrACE approach to the management of fatigue in CLD patients

Treat the treatable	Underlying liver disease: autoimmune, viral, metabolic, etc.
	Hypothyroidism
	Arthritis
	Coeliac disease
	Type 2 diabetes mellitus
	Anaemia
Ameliorate the ameliorable	Sleep disturbance (especially daytime somnolence)
	Autonomic dysfunction
	Depression
	Itch
	Avoid or discontinue benzodiazepines, antidepressants, muscle relaxants, first-generation antihistamines, β-blockers, opioids
Cope	“Ownership of the problem”
	Help patients to develop coping strategies
	Physical activity and diet
	Psychological help
	Social support
Empathise	Try to understand the impact of fatigue on the patient
	Be optimistic: “don’t fail before you start”