Determining the Cause

a. History: Nausea with vomiting

Differential Diagnosis

Adrenal insufficiency, Liver Failure (determine Etioogy), Viral hepatitis, Gastrointestinal neoplasia

Pivotal Assessment	Findings
History	African descent	Cancer, History of	Change in menstrual cycle, if female	Constipation, dry skin, and weight gain	Dyspnea and Malaise	Fever	Pain	psychological distress, and	sleep loss	Weakness	Weight Loss
Physical Exam	Jaundice
Lab Test	Elevated TSH						Hemoglobin_Hematocrit, Low

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