Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

I’m Deathly Tired….The Fatigue Work Up

Neda Frayha, MD and Heidi James, MD
00:00
22:25
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Fatigue is a very common symptom in primary care.  Unfortunately, the cause is rarely found. Taking a thorough history and doing a physical exam may identity the cause of the fatigue or help direct further investigations.  The differential is wide and encompasses many cardiovascular, respiratory, endocrinologic, and psychiatric conditions. Even with such a broad differential, many causes remain categorized as “NYD”.  Neda and Heidi describe a tier-like approach to ordering investigations and discuss how to help you patient manage this debilitating symptom.

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Sarah H., ARNP -

Thanks for the great overview. Do you include EKG in your "first pass" work up?

Heidi J., MD -

Hi Sarah - We'll include an EKG if our history and physical leads us down the CV disease as a potential cause (i.e. bradycardia on exam, syncope on hx) , but it is not part of our usual first pass.

Ian L., Dr -

There is recognition of Primary Hyperparathyroidism as common endocrine disorder in persons over 65 -1.5% particularly Post Menopausal Women -2.5 to 3%
Therefore a Serum Calcium ionised and ionised and albumin are definetly on the list for fatigue in over 65 and Post Menopausal Women.
There is debate about treatment but the consensus is at this time in mild asymptomatic cases watchful waiting and yearly tests of Calcium Parathroid Hormone Bone Mineral Density and good fluid intake is satisfactory .
Parathroidectomy on 2% of those over 65 seems radical !

John K., MD -

Great overview. It's reassuring to know that this is just hard to figure out, it's not just me. The stats will be helpful in my initial discussion with folks to sort of gauge expectations.

Heidi J., MD -

Thanks, John! Managing expectations is key to so much of what we do.

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
It's Bloody Halloween! Full episode audio for MD edition 187:22 min - 88 MB - M4AHippo Primary Care RAP - October 2017 Summary 2 MB - PDF