diagnosis
Last reviewed 01/2018
A definitive diagnosis of fatigue is difficult to make. The objective is to identify any underlying physical, psychosocial or physiological factors which may be the source of tiredness.
- medications and toxic exposures
- long-acting antihistamines, corticosteroids, neuroleptics, antiarrhythmics (e.g., amiodarone), antidepressants and antihypertensives (e.g., clonidine, alpha methyldopa and beta-blockers) and some herbal remedies
- environmental toxins - carbon monoxide, lead, mercury and arsenic (1)
- history
- fatigue's duration (recent, prolonged or chronic), onset (sudden or progressive), recovery period (short or long)
- patients physical activity (sedentary or active) (1)
- aggravating and relieving factors (2)
- particular useful in differentiating chronic fatigue from chronic fatigue syndrome (CFS) - CFS presents with sudden onset with recovery occurring in hours or days
- psychiatric assessment
- fatigue is the chief complaint in most of the psychiatric disorders (3)
- should enquire about depression, stress, anxiety, eating disorders, somatisation disorder (2,3)
- substance abuse (caffeine, alcohol and illicit drugs)
- assessment for sleep disorder
- sleep apnoea, excessive sleepiness and parasomnias (1)
- sleep apnoea, excessive sleepiness and parasomnias (1)
- physical examination
- to identify any organ based diseases e.g - breathlessness, weight loss, anorexia (2)
The following can be used as first line investigations in primary care to rule out any serious and common underlying diseases:
- FBC
- ESR
- thyroid stimulating hormone
- fasting blood glucose level
- additional possible investigations include:
- liver function test
- serum urea, electrolyte and creatinine levels
- serum ferritin (indicated as an initial investigation in children and young adults only)
- urinalysis for protein, blood and glucose
- blood test for gluten sensitivity
- serum calcium (1,2)
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