Determining the Cause
Chief Complaint: Fatigue
Pivotal Assessment
Findings
History
A
Cancer, History of
Constipation, dry skin, and weight gain
Dyspnea and Malaise
Weakness
Weight Loss
Physical Exam
Jaundice
Lab Test
Elevated TSH
Hemoglobin_Hematocrit, Low
4
Fatigue very often occurs with other concerns, especially pain, psychological distress, and sleep loss
:
Involuntary weight loss may suggest one of several neoplasias, infections, or endocrine disorders
Fever may suggest an infection or a hematologic malignancy
Dyspnea on exertion may suggest heart failure, coronary artery disease, or primary pulmonary disease
Nausea with vomiting may suggest an unusual cause such as adrenal insufficiency, viral hepatitis, or gastrointestinal neoplasia
Myalgias may suggest a rheumatologic condition such as fibromyalgia (diffuse muscle pain) or polymyalgia rheumatica (shoulders and hips)
Morning stiffness or arthralgias may suggest rheumatoid arthritis
Sad mood, poor memory, or lack of concentration may suggest depression
Involuntary weight loss could imply an occult onset of, or recurrence of, malignancy or hyperthyroidism
Weight gain could imply atypical depressive episode or hypothyroidism
Blurry or double vision, as well as paresis or numbness of extremities, could be consistent with multiple sclerosis
Snoring with daytime somnolence may suggest sleep apnea
Menometrorrhagia may suggest anemia or iron deficiency
Socioeconomic factors
Life events such as death of a loved one, job loss, or retirement may precipitate fatigue
Lifestyle factors
Inadequate sleep duration or poor quality of sleep may suggest a primary sleep disorder or depression
Unusual dietary patterns (including fad diets) may suggest nutritional deficiency
Vigorous exercise schedule in athletes may suggest overtraining
Injection drug use poses a risk for HIV or hepatitis B infection
OTC and prescription drug use
Common drug class culprits are β-blockers, antihistamines, muscle relaxants, and benzodiazepines
Illicit drugs and alcohol
Recreational drugs such as marijuana and cocaine may lead to fatigue
Excessive alcohol consumption may disrupt sleep