Fatigue, Malaise

Patient w/ fatigue.
Differential diagnosis.
Labs
CBC, CMP, TSH, 25-OH Vit D.
Creatine Kinase (if muscle pain or weakness
Treatment
Counseling provided.
Sleep hygiene. Hydration. Exercise. Healthy Diet.
Will treat cause when identified.
Will do an empiric trial of antidepressants if depressive symptoms present even if criteria for MDD not met.
If no improvement will try CBT and /or graded exercise therapy

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Chronic Fatigue workup

The CDC recommends the following as a typical standard battery of tests to work up chronic fatigue syndrome and exclude other causes of fatiguing illness:

CBC with differential (Check for anemia, infection, hematologic malignancy)
CMP (ALT, Albumin, Alkaline phosphatase, BUN/Cr, Calcium, electrolytes, glucose, phosphorus)
TSH
ESR – Check for giant cell arteritis and PMR etc.
Globulin
Phosphorus
Transferrin saturation
Urinalysis
HIV
Pregnancy test (if indicated)

Some doctors also include:

ANA (if autoimmune disease is suspected on the basis of H&P and initial tests)
Morning cortisol.

Only rarely order the following tests if needed.

CXR; ECG; PFTs; MRI of Brain; Echocardiography;
Toxicology screen
Tuberculin skin test; Lyme titers; Rapid plasma reagin;
Anemia workup: Ferritin, iron, vitamin B₁₂, and folate levels; iron-binding capacity; direct antiglobulin test

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