Thread by @AnandJag1

“Doc, I feel weak all over”

This chief concern came up many times in the past couple weeks on wards and in @hdx case editing.

So I asked, why do people feel weak?

#Medtwitter, join me while I scheme(a) on “generalized” weakness...

@hdx 1/
First: does the patient just FEEL weak (subjective), or do they have TRUE weakness (objective)?

Many things can manifest with a subjective feeling of weakness without actually affecting objective muscle strength.

@hdx 2/
Subjective weakness, or Asthenia can be generated by a number of conditions.

Ask yourself:
-Do they have chronic CV/lung/kidney disease?
-Anemic?
-Are they infected?
-How is their mood?

Wait, can’t some of these cause true weakness? Yes, more soon...

@hdx 3/
Quick pause re: mood.

Can’t emphasize enough the importance checking both a radial AND mental pulse. It’s amazing how much weakness you’ll improve with a few questions, SSRIs, and counseling.

Ask your patients, “How is your mood?”

@hdx 4/
Objective weakness -> impaired muscle function.

Screening lytes (K, Ca, Mg) is fast and cheap. If unrevealing, use H&P to target special labs/tests:

-Myopathy?
-Nerve/synapse issue (NCS)?
-Inflammation to blame (bx, Ab)?

@hdx 5/
Back to 2/, conditions spanning the spectrum of subj/obj weakness.

-CV/lung disease/anemia (when bad) -> tissue hypoxia -> objective weakness.
-Infection (cytokines!)
-Endocrinopathy (thyroid, adrenals)
-Malignancy
-Uncommon things

@hdx 6/
Summary:

-Weakness can be subjective and/or objective
-Screen for mood disorders!
-Asthenia can progress to objective weakness

#Medtwitter, as always, appreciate your feedback, help make this better!

@hdx Updated schema below. Thanks for all the suggestions! 🙏

For a deep-dive, check out this great interactive resource on weakness (with cases!) shared by @SFahmyIN

prezi.com/fm67jjcle0xp/a…