1. A lowered level of consciousness, with drowsiness, listlessness, and apathy. Lethargy is a fairly imprecise description of the feeling or slowness, sluggishness, tiredness, or lack of energy. Lethargy in common usage may mean many things, including fatigue, drowsiness (sleepiness), lethargy, tiredness, malaise, listlessness, or weakness (including muscular weakness). The causes of these other similar symptoms also need to be investigated in researching a symptom of lethargy. Nevertheless, any type of lethargy symptom can indicate a serious medical condition and needs prompt medical investigation.
Diagnosis of Lethargy
* Blood tests
* Full blood count and ESR
* Electrolytes including calcium and magnesium - low potassium with Conn's syndrome). * Renal function tests
* Liver function tests
* Blood sugar
* Thyroid function tests
* Pregnancy test, if indicated
* Iron studies to detect iron deficiency and hemochromatosis * Serum cortical - to help differentiate Addison's disease and hypopituitarism. * Celiac screen - if indicated.
* Syphilis screen - if indicated.
* ANA test, Rheumatoid factor and serum complement - to screen for autoimmune disorders. * HIV serology - if indicated.
* Chronic infection screening ( such as Hepatitis A,B,C,D and E, cytomegalovirus, Epstein-Barr virus, Ross River virus, Lyme disease, brucellosis, Q fever, tuberculosis, malaria, infective endocarditis, toxoplasmosis) * Serial blood cultures, if there is a significant fever * Tissue markers for malignancy
Causes of Lethargy
The following medical conditions are some of the possible causes of Lethargy. * Hemolytic anemia
* Bipolar disorder
* Congestive heart failure
* Folic acid deficiency anemia
* Aplastic anemia
* Adrenal insufficiency
* Diabetes mellitus
* Rheumatoid arthritis
* Toxic shock syndrome
* Infectious mononucleosis
* Diabetes melitis
Some of the possible treatments listed in sources for treatment of Lethargy may include: * Over the counter analgesics
* Green leafy vegetables
* Ferrous sulphate
* Ferrous gluconate
* Vitamin C
What is Tiredness?
Tiredness can be a complex complaint for doctors to investigate. In many situations the tiredness may just be “tiredness”, or the result of lifestyle causes. But less frequently, tiredness will be the indication of a serious clinical diagnosis. The challenge for the GP is to be able to diagnose significant disorders without over investigating minor conditions.
Causes of Tiredness
The causes of tiredness can be usefully divided into three overlapping groups. Many presentations will not fit into these group and the causes will remain unknown. They are Lifestyle, psychosocial and physical.
Lifestyle causes may result of:
* Significant life stresses
* The demands of occupation or family
* Diet-excessive food or diet fads
* Alcohol and street drugs
* Exercise-over and under exercise
* Sleep disorders
Psychosocial causes may result of:
Often overlap with lifestyle causes of tiredness. Anxiety, stress and interpersonal difficulties affect quality of life and are often amenable to interventions. Depression needs early identification because of the morbidity and threat to associated with untreated depression.
Physical causes can also make someone tired. These physical causes may not always be obvious. They may include: * Co- Morbidities
* Medication-many drugs cause tiredness
* New condition presenting as tiredness
Patients under 50yrs without other risk factors. The following test is required. * Complete Blood Count – CBC