First establish what is
meant by fatigue- distinguish:
• Daytime
Sleepiness
• Shortness
of breath
• Lack
of energy
• Limb
weakness
• Lack
of motivation
• Duration (recent, prolonged, or chronic)
• Sudden or progressive onset (e.g., chronic fatigue syndrome is usually sudden-onset)
• Recovery period (e.g., the course of chronic fatigue syndrome is
associated with intermittent periods of recovery lasting hours or days)
• Impact of rest (physiological versus non-physiological fatigue)
• Impact of physical activity or mental activity (e.g., chronic fatigue
syndrome is typically exacerbated by relatively minor physical or mental
activity)
• Level of physical activity (sedentary lifestyle is a cause of fatigue,
and patients may benefit from exercise therapy) and concomitant presence of
weakness (e.g., reduced muscle power at rest may point to a neuromuscular
disorder) [76]
• Seasonality and any current influenza outbreak (which occur most
commonly in the winter).
•
• Age:
people 60 years or older usually have an underlying cause for chronic fatigue,
whereas in the 30 to 39 years age group the cause is more likely to be
idiopathic chronic fatigue [6] [80]
• Residence
in, or travel to, areas where certain infections are endemic (TB)
• Exposure
to infections via work with cows or ingestion of unpasteurised dairy products
(brucellosis), or via ingestion of uncooked meat and contact with a kitten
(toxoplasmosis)
• History
of immunosuppression or use of immunosuppressive drugs (cytomegalovirus
infection)
• Occupational,
recreational, and residential exposure to tick-infested woods or fields near
woods (Lyme disease)
• History
of intravenous drug use and unprotected sexual intercourse (HIV/hepatitis B or
C virus infection)
• Sleep
deprivation and a sedentary lifestyle are important causes of fatigue but are
often overlooked
• Cardiovascular
risk factors (acute coronary syndrome)
• Steatorrhoea, weight loss (coeliac disease)
• Sore
throat (EBV infection)
• Fever
with cough, sore throat, runny nose (influenza infection)
• Menometrorrhagia
(anaemia)
• Polyuria,
polydipsia (diabetes mellitus, hypopituitarism)
• Dyspnoea
(cardiac failure, chronic lung disease)
• Visual
field defect (multiple sclerosis)
• Cold
intolerance, overweight (hypothyroidism)
• Heat
intolerance, decreased weight despite increased appetite (hyperthyroidism)
• Arthralgia
or rash (autoimmune disease)
• Weight
loss, blood in stool (malignancy, anaemia)
• Recent
viral infection (post-viral illness)
• History
of stroke (cerebrovascular disease).
|
Haematological |
|
|
Anaemia |
FBC |
|
Iron deficiency |
Iron studies |
|
Myelodysplasia |
Blood film |
|
Endocrine |
|
|
Diabetes |
BSL |
|
Thyroid disease |
TFTs |
|
Adrenal
insufficiency |
Early morning
cortisol + Short synacthen test (unless early morning cortisol high
normal) |
|
Metabolic |
|
|
Liver failure |
LFTs |
|
Chronic renal
insufficiency |
Creatinine |
|
Cardiovascular
disease |
|
|
Heart failure |
BNP, CXR |
|
Post- AMI |
|
|
Arrhythmia (AF) |
ECG |
|
Respiratory |
|
|
COPD |
CXR, RFTs |
|
OSA |
Sleep study |
|
Infections |
|
|
Hepatitis |
Hepatitis
serology |
|
HIV |
HIV serology |
|
EBV |
EBV serology |
|
CMV |
CMV serology |
|
Brucellosis |
Brucellosis
serology and culture |
|
TB |
Quantiferon, CXR |
|
Toxoplasmosis |
Toxoplasmosis
serology |
|
Giardia |
Stool culture |
|
Autoimmune
disease |
|
|
Rheumatoid/SLE
etc. |
ESR, Autoimmune
panel |
|
Coeliac disease |
Coeliac
serology |
|
Neurological
conditions |
|
|
Myaesthenia gravis |
Anti-ACh RA (+/- SFEMG) |
|
MS |
+/- MRI |
|
Malignancy |
|
|
|
ESR, LDH, Screen for red flags |
|
Drugs/Medications |
|
|
|
R/V medication
list |
|
Alcohol abuse |
Alcohol abuse
questionnaire |
|
Other |
|
|
Chronic Fatigue
Syndrome |
|
|
Fibromyalgia |
|
|
Chronic
idiopathic fatigue |
|
|
|
|