II. Indications

  1. Fatigue Evaluation
  2. Chronic Fatigue Syndrome Evaluation

III. Evaluation: Clinic and home monitoring

  1. Serial weights
  2. Serial AM and PM Body Temperatures

IV. Labs: Reasonable directed screening for Fatigue (abnormal in only 5% of Fatigue cases)

  1. Complete Blood Count (CBC)
    1. Consider Serum Ferritin as well
    2. Consider Vitamin B12 if macrocytosis
  2. C-Reactive Protein (C-RP) or Erythrocyte Sedimentation Rate (ESR)
    1. Consider Antinuclear Antibody if abnormal
  3. Comprehensive metabolic panel
    1. Includes Serum Glucose (consider Fasting)
    2. Includes serum Electrolytes
    3. Includes Renal Function testing
    4. Liver Function Tests
      1. Consider Viral Hepatitis Screening if abnormal
  4. Thyroid Stimulating Hormone (TSH)
  5. Urinalysis
  6. Urine Pregnancy Test (in women of child-bearing age)

V. Labs: Other Diagnostic Testing to consider if indicated

  1. Immunoglobulin A endomysial antibodies or tissue transglutaminase (TTG) for Celiac Disease
  2. Chest XRay
  3. HIV Test
  4. Electrocardiogram
  5. Echocardiogram
  6. Lyme Titer
  7. PPD Skin Testing
  8. Urine Toxicology Screen
  9. Serum Phosphorus

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