Table 2. The basic diagnostic evaluation of fatigue (e41)*.
| History | ||
| ● symptom characteristics, differentiation from somnolence ● associated complaints ● fatigue new/unusual ● impairment in everyday life ● the patient’s own conception of the cause and treatment of fatigue ● symptoms of depression and anxiety |
● somatic history ● sleep: duration, quality, changes from personal norm, (habitually) insufficient sleep ● body weight, changes in weight ● cardiac, respiratory, gastrointestinal, urogenital, and central nervous system function ● drugs, psychotropic substances ● post-infectious state, chronic disease |
● social, familial, occupational situations ● exposure to chemicals or noise ● similar symptoms in family members, friends, or coworkers ● snoring, falling asleep at the wheel |
| Physical examination | ||
| ● depending on positive findings in the history | ● if the history does not arouse suspicion of any particular physical illness: abdomen, heart, circulation, airways, skin and mucous membranes, lymph nodes; muscle bulk, strength, and tone; proprioceptive reflexes | |
| Laboratory testing | ||
| ● depending on positive findings in the history and physical examination | ● if there is no evidence of any particular physical illness: fasting blood sugar, complete blood count, erythrocyte sedimentation rate/CRP, transaminases/γ-GT, TSH (creatinine only if there is evidence of renal disease, or in the presence of risk factors such as hypertension, diabetes, nephrotoxic drugs) |
● further laboratory testing only if the history or physical examination arouses suspicion of a particular condition ● ferritin measurement in premenopausal women with normal history, physical examination, and basic laboratory tests |
* These recommendations are also given in the DEGAM guideline.