Lethargy/Fatigue

Question 1

Fatigue:

Domains to consider when starting diagnostic process?

Answer 1

1) Psychological Health
- adjustment disorders
- axis one disorders
- drugs and alcohol

2) Physical Health
- sleep
- nutrition, appetitie and weight loss
- physical activity
- medical conditions (Infections, CVD, respiratory, endocrine, rheumatological, neoplastic, haematological)
- medications

3) Social Health
- stressors (employment, relationships, finances)

Question 2

Fatigue:

Most likely causes?

Answer 2

• stress
• depression/anxiety
• infection
• sleep issues

Question 3

Fatigue:

Not to be missed causes?

Answer 3

• Anaemia
• Malignancy
• Cardiomyopathy/arrhythmia
• Haemachromatosis
• blood bourne viruses

Question 4

Fatigue:

commonly missed causes?

Answer 4

• depression
• coeliac/food intolerance
• chronic infections
• CCF
• fibromyalgia
• lack of fitness
• menopause
• CVA, MS
• renal failure
• endocrine conditions (PTH, cortisol, Aldosterone)
• rheumatology (RA, SLE)
• spinal dysfunction

Question 5

Fatigue:

Approach to testing?

Answer 5

1) If the history suggestive of a diagnosis then manage or investigate that initially
-always screen onsite urine and BSL
2) Delay testing for 4 weeks unless red flags below (same test apply post delay in testing) OR
If any red flags (new onset in well person, unintentional weight loss, abnormal bleeding, shortness of breath, unexplained lymphadenopathy, fever, progression of CVS/GIT/neurologial/rheumatological symtpoms) then test:
-CBE
-UEC
-LFT
-CRP and ESR
-glucose
-TSH
-ferritin
*coeliac serology if felt warranted