Loss of Energy

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of fatigue

Severity is ‍mildmoderatesevere and impact on daily activities is ‍minimal

Pattern ‍persistentintermittent

Worse with ‍exertionmental activitystress

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍dizziness

‍anorexia

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍constipation

‍hematochezia, ‍bright reddark red, ‍around stoolsmixed with stools, ‍withwithout clots

‍melenic stools, ‍withwithout strong foul smell

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍polyuria

‍polydipsia

‍dyspnea, ‍at reston exertion

‍palpitations

‍hair loss

‍dry skin

‍cold intolerance

‍night sweats

‍fever, up to ‍°, over ‍ ‍hoursdays

‍body aches

‍muscle weakness

‍joint pain

‍depression

‍insomnia

‍cognitive impairment

‍irritability



Contributing factors:

‍sedentarity

‍excessive alcohol

‍drug use

‍high stress

‍recent illness

‍lack of sleep

‍pregnancy

no history of: ‍fibromyalgia, ‍hypothyroidism, ‍anemia, ‍diabetes, ‍heart disease, ‍depression, ‍anxiety, ‍sleep apnea, ‍renal disease, ‍liver disease, ‍head trauma, ‍Covid-19

no use of: ‍antidepressants, ‍sedatives, ‍thyroid medication, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Fatigue due to psychosocial stressors ‍likelysuspectedpossible

DDx: psychosocial stressors, anemia, thyroid disease, sleep apnea, depression, chronic fatigue syndrome, diabetes mellitus, chronic kidney disease, liver disease, heart failure, COPD, medication side effect, viral infection (e.g. mononucleosis, hepatitis, HIV), electrolyte imbalance, nutritional deficiencies, rheumatologic conditions, malignancy, chronic pain syndrome, overtraining syndrome, adrenal insufficiency, Cushing syndrome, hypogonadism, pregnancy, head trauma, long Covid





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍vitamin B12, ‍folate, ‍ferritin, ‍iron studies, ‍CRP, ‍β-hCG, ‍mono spot test, ‍EBV antibodies, ‍HIV, ‍syphilis, ‍HBsAg, ‍hepatitis C

- Urinalysis

- ECG

- Chest X-ray

- Sleep study

Treatments:

- Lifestyle modifications: ‍healthy diet, ‍regular exercise, ‍good sleep hygiene, ‍stress management techniques

- ‍Antidepressants

- ‍Stimulants

- ‍Iron supplements

- Multi-vitamins

Further care:

- Referral to psychologist

- Referral to sleep specialist

- Referral to endocrinologist

- Follow-up in ‍ ‍weeksmonths

- Return if fatigue worsens or if new symptoms develop such as weight loss, fever, or persistent sleep disturbances