From the Research
The workup for lethargy in a 68-year-old male should begin with a comprehensive history and physical examination to identify potential causes, followed by initial laboratory tests including complete blood count, comprehensive metabolic panel, thyroid function tests, urinalysis, and blood glucose measurement. This approach is crucial in identifying potential underlying causes of lethargy, which can be multifactorial in older adults. According to 1, a complete blood cell count (CBC) is one of the most common laboratory tests in medicine, and understanding its basics as well as having a structured action plan when confronted with abnormal results is essential.
Key components of the workup include:
- Comprehensive history and physical examination
- Initial laboratory tests:
- Complete blood count
- Comprehensive metabolic panel
- Thyroid function tests
- Urinalysis
- Blood glucose measurement
- Additional tests to consider:
- Vitamin B12 and folate levels
- Inflammatory markers (ESR, CRP)
- Morning cortisol level
- Medication review to identify potential causes of lethargy
- Neuroimaging with CT or MRI of the brain if there are focal neurological findings or concern for intracranial pathology
- Screening for depression using tools like the Geriatric Depression Scale
- Sleep studies if sleep apnea is suspected
- Cardiac evaluation including ECG and possibly echocardiogram to rule out heart failure or arrhythmias
- Infectious disease workup including chest X-ray, blood cultures, and urinalysis with culture if infection is suspected.
Given the potential complexity and multifactorial nature of lethargy in older adults, a systematic approach is necessary to identify reversible causes and improve quality of life.