Fatigue

1.  Define “Fatigue” — Distinguish from other symptoms, esp. true “weakness”:

  • Weakness” = Neurologic diseases, rare but possibly very serious.  Patient may fall, or drop things. Identified by finding actual muscle weakness when testing patient’s strength
  • Fatigue” = feeling worn out, but muscle strength is normal when tested
  • Shortness of Breath = Heart or Lung disease.  Suspected if patient feels they “huff & puff” with simple exertion
  • Sleepiness = nodding off in daytime, suggests Sleep Apnea or Narcolepsy
  • Aches” suggest muscle disease like fibromyalgia, or more serious conditions. See Body Aches

2.  Define Time Frame:

  • Acute Fatigue  =  โ‰ค1 month (more concerning)
  • Chronic Fatigue  =  >6 months (unlikely to be dangerous)
  • If 2-6 months  =  “Acute” if getting worse; “Chronic” if staying the same

3.  Consider Possible Diagnoses

Causes of “Fatigue” as a Symptom

xxxxxxINFECTIONS

โ€ข Heart (a low-grade one) **
โ€ข Bacterial (one that’s not xxxobvious)**
โ€ข Mononucleosis **
โ€ข HIV
โ€ข Hepatitis (acute or chronic)
โ€ข Tuberculosis
โ€ข Other  


IDIOPATHIC (Unknown Cause)

โ€ข Chronic Fatigue Syndrome (whether meets the CFS case-definition or not)


x
xxxMETABOLIC DISORDERS
 
โ€ข Blood Abnormalities xxxsodium, potassium, xxxcalcium, etc. **
โ€ข Kidney Failure
โ€ข Liver Failure: acute / chronic


xxxENDOCRINE DISEASES
 
โ€ข Diabetes
โ€ข Hypothyroidism
โ€ข Hyperthyroidism
โ€ข Adrenal Insufficiency
โ€ข Pituitary Insufficiency   


**  Not likely once symptom has become Chronic
xxxxxxxOTHER
ย 
โ€ข Cancer (various) **
โ€ข Depression
โ€ข Anxiety
โ€ข Drugs / Alcohol / Medicines
โ€ข Drug Withdrawal
โ€ข Anemia (mod.-severe)
โ€ข Celiac Disease
โ€ข Malnutrition
โ€ข Rheumatologic disorders
xxx(see Joint Pain)
โ€ข Any Chronic Condition that’s xxbothersome (stomach acid, xxallergies, etc.)


x
x
x

4.  Think about possible Red Flags 

May be serious (e.g. cancer), get CT Scans if no diagnosis from basic lab tests (below):

  • Fevers
  • Night Sweats (drenching)
  • Weight Loss

5.  Basic Lab Tests if no diagnosis obvious from History & Physical Exam:

6.  Patient returns in 3 weeks  โ†’ review labs and Check Weight

  • Pursue any significant lab abnormalities
  • If significant weight loss, needs CT Scans chest, abdomen, pelvis, & more work-up

7. No Weight Loss & All Tests Normal (No Red Flags)

  • Depression or Anxiety are most likely diagnoses, often due to personal stressors.  Treat these if any possibility
    • If Depression, essential to exclude thoughts of suicide
  • Essential to exclude possible Domestic Violence (esp. for vulnerable persons)
  • Chronic Fatigue Syndrome is default diagnosis of exclusion (nothing else), symptoms often lasting many months
  • Ongoing follow-up to be sure no Red Flags develop, no new symptoms needing work-up

See Fatigue โ€” Full Text for more in-depth explanations and discussions.

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