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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Steven Doerr, MD

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

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For the evaluation of fatigue, the health care practitioner will take a complete history of the patient's fatigue, along with questions in regard to associated symptoms.

The health care practitioner may inquire about the following activities and symptoms to determine the probable cause of the fatigue:

Quality of Life

• Does the level of fatigue remain constant throughout the day? Does the fatigue get worse as the day goes on, or does the fatigue begin at the start of the day?
  
  
• Is there a pattern to the fatigue (time of day or time of year like the holidays)? Does the fatigue occur at regular cycles?
  
  
• How is the person's emotional state? Does the person feel unhappiness or disappointment in life?
  
  
• Sleep pattern determination:
  
  
  • How much sleep is the person getting?
    
    
  • During what hours does the person sleep?
    
    
  • Does the person awake rested or fatigued?
    
    
  • How many times does the person awake during sleep? Are they able to fall back asleep?
  
  
• Does the person get regular exercise? Any exercise?
  
  
• Has the person had any new stressors in their life? Change in relationships, jobs, school, or living arrangements?
  
  
• What is the person's diet? Is there a high intake of coffee, sugar, or excessive amounts of food?
  
  
• Associated symptoms (not all inclusive as answers may trigger other questions):
  
  
  • fever,
    
    
  • pain,
    
    
  • nausea,
    
    
  • vomiting,
    
    
  • diarrhea,
    
    
  • blood in urine or stool,
    
    
  • shortness of breath,
    
    
  • chest pain,
    
    
  • constipation,
    
    
  • muscle cramps or aches,
    
    
  • easy bruising,
    
    
  • cough,
    
    
  • changes in thirst or urination,
    
    
  • inability to sleep lying flat,
    
    
  • inability to walk up more than one flight of stairs,
    
    
  • changes in appetite,
    
    
  • loss or gain of weight,
    
    
  • menstrual irregularities,
    
    
  • swollen legs, and/or
    
    
  • mass in breast.

After obtaining the history, a physical exam will be performed, focusing on the patient's vital signs (weight, blood pressure, heart rate, temperature, breathing rate). The doctor will observe the patient's general appearance, listen to the heart, lungs, and abdomen, and may perform a pelvic and rectal exam. The doctor may order some of the following tests depending on the suspected underlying cause of the fatigue.

• Blood tests provides information about an infection, anemia, or other blood abnormalities or problems with nutrition.
  
  
• Urinalysis provides information that might point to diabetes, liver disease, or infection.
  
  
• Chem-7 looks at 7 common substances circulating in the blood. It consists of electrolytes (sodium, potassium, chloride, and bicarbonate), waste products of metabolism cleared by normally functioning kidneys (BUN and creatinine) and the source of energy for the body's cells (glucose).
  
  
• Thyroid function tests examine the function of thyroid gland (thyroid levels too high or too low).
  
  
• Pregnancy test
  
  
• Sedimentation rate test checks for chronic diseases or inflammatory conditions.
  
  
• HIV test
  
  
• Chest X-ray looks for infections or tumors.
  
  
• Electrocardiogram (ECG) is an electrical recording that looks at the function of the heart.
  
  
• CT scan of head is a A 3-dimensional X-ray of the brain to look for stroke, tumors, or other abnormalities.

The definitive diagnosis depends on discovering the underlying cause of the fatigue; this is determined by evaluating the history, the physical exam and the appropriate test results.

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