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. Serum Phosphorus
  5. Thyroid Stimulating Hormone (TSH)
  6. Urinalysis
  7. 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

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Related Studies

Ontology: Fatigue (C0015672)

Definition (CCC) Exhaustion that interferes with physical and mental activities
Definition (MEDLINEPLUS)

Everyone feels tired now and then. Sometimes you may just want to stay in bed. But, after a good night's sleep, most people feel refreshed and ready to face a new day. If you continue to feel tired for weeks, it's time to see your doctor. He or she may be able to help you find out what's causing your fatigue and recommend ways to relieve it.

Fatigue itself is not a disease. Medical problems, treatments, and personal habits can add to fatigue. These include

  • Taking certain medicines, such as antidepressants, antihistamines, and medicines for nausea and pain
  • Having medical treatments, like chemotherapy and radiation
  • Recovering from major surgery
  • Anxiety, stress, or depression
  • Staying up too late
  • Drinking too much alcohol or too many caffeinated drinks
  • Pregnancy

One disorder that causes extreme fatigue is chronic fatigue syndrome (CFS). This fatigue is not the kind of tired feeling that goes away after you rest. Instead, it lasts a long time and limits your ability to do ordinary daily activities.

NIH: National Institute on Aging

Definition (NCI) Overall tiredness and lack of energy.(NICHD)
Definition (NCI) A question about whether an individual has or had a lack of energy.
Definition (NCI_NCI-GLOSS) A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.
Definition (NCI_CTCAE) A disorder characterized by a state of generalized weakness with a pronounced inability to summon sufficient energy to accomplish daily activities.
Definition (NAN) An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level
Definition (MSH) The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.
Definition (CSP) state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.
Concepts Sign or Symptom (T184)
MSH D005221
ICD10 R53.83
SnomedCT 206767001, 206771003, 158169005, 367392001, 302758002, 139126000, 84229001, 248274002
LNC MTHU013358, LA7542-9
French FATIGUE, Fatigue extrême, Perte d'énergie, Energie diminuée, Ereinté, Lassitude, Sensation de manque total d'énergie, EPUISEMENT, FAIBLESSE, LASSITUDE, Fatigue
English FATIGUE EXTREME, TIREDNESS, WEARINESS, [D]Fatigue, [D]Tiredness, [D]Fatigue (context-dependent category), [D]Tiredness (context-dependent category), Extreme fatigue, Decreased energy, decreased energy, fatigue (diagnosis), fatigue, Feeling of total lack of energy, Fatigue extreme, Tired out, Fatigue NOS, Fatigue [Disease/Finding], rndx fatigue (diagnosis), rndx fatigue, lacking energy, fatigues, loss of energy, tired time, tiredness, fatigue extreme, extreme fatigue, weariness, fatigued, tatt, time tired, energy loss, fatiguing, tired all the time, Lacks Energy, [D]Fatigue (situation), [D]Tiredness (situation), Lacking in energy (finding), Tiredness (finding), I have a lack of energy, FATIGUE, Lack Energy, Energy decreased, Tiredness, Lack of energy, Loss of energy, Weariness, Fatigue (finding), Lack of energy (finding), Lacking in energy, Fatigue, Lack of Energy, lack of energy, Lack (of);energy
Portuguese FADIGA, Fadiga extrema, Sensação de falta total de energia, Perda de energia, Exausto, Energia diminuída, CANSACO, ESGOTAMENTO, EXAUSTAO, Fadiga
Spanish FATIGA, Abatimiento, Sensación de falta absoluta de energía, Pérdida de energía, Fatiga extrema, Cansado, Cansancio, Falta de energía, [D]cansancio (categoría dependiente del contexto), [D]fatiga (categoría dependiente del contexto), ABATIMIENTO, CANSANCIO, FATIGA EXTREMA, [D]cansancio (situación), [D]cansancio, [D]fatiga, faltante de energía, faltante de energía (hallazgo), [D]fatiga (situación), cansancio, falta de energía (hallazgo), falta de energía, fatiga (hallazgo), fatiga, pérdida de energía, Fatiga
German ERMUEDUNG, Mangel an Energie, Muedigkeit extrem, Ueberdruss, Energie abgenommen, abgeschlafft, Gefuehl voelligen Energiemangels, Muedigkeit, ABGESCHLAGENHEIT, MUEDIGKEIT STARK, MUEDIGKEIT, Ermuedung, Ermüdung, Müdigkeit
Italian Affaticamento, Affaticamento estremo, Esaurito, Sensazione di totale mancanza di energia, Perdita di energia, Energia ridotta, Stanchezza
Dutch vermoeid, moeheid, uitzonderlijk moe, verlies van energie, gevoel van energieloosheid, energie afgenomen, vermoeidheid, Moeheid
Japanese 活力低下, 活力喪失感, 活力喪失, 疲労困ぱい, 極度の疲労, 疲労, ヒロウコンパイ, カツリョクテイカ, カツリョクソウシツカン, ヒロウ, キョクドノヒロウ, カツリョクソウシツ
Swedish Trötthet
Czech únava, Utahanost, Extrémní únava, Utahaný, Ztráta energie, Úbytek energie, Únava, Vyčerpanost, Pocit celkového nedostatku energie
Finnish Väsymys
Croatian UMOR
Polish Znużenie, Zmęczenie
Hungarian Kimerültség, Defatigatio, Kifáradt, Teljes energiahiány érzete, Energia elvesztése, Fáradtság, Kimerültség, extrém, Csökkent energia
Norwegian Tretthet, Utmattelse, Trøtthet, Fatigue