Fatigue Detectives

Fatigue in an otherwise healthy young man (late teens/early 20's I think). What can this be? Too much heat and humidity? He is a counselor at the local summer camp and does a good job but is just wiped out by day's end and has to nap a couple of hours. We are pleased with his work, just concerned that he might be too tired to be safe. We are thinking of sending him to the camp doctor for a Physical and some basic labs, like CBC with differential, CMP.

The other nurse and I have talked about hepatitis, HIV, cancer, anemia, chronic fatigue syndrome, Epstein-Barr. He denies GU, GI c/o, has no rashes or open lesions, except for a healing infected pimple, which is almost all cleared up. He says he's been using hot soaks and TAO. Denies exposure to any known toxins, denies allergies, says he's sleeping 8-9 hours per night. So that's infection, Endocrine (hmm, wonder if it's thyroid), GI, GU, derm. Per his pre-employment PE, his cardiorespiratory status is WNL except for a post-exertion 1st degree murmur - not sure which valve. Hmm, maybe I just got my answer, although he has no SOB, CP, edema, and even says he feels better after exercise. He says he works out in the wt room and runs 4-5 x/week! I should be doing so well. :chuckle

Has anyone seen cases like this? Diet is well-rounded, from what he tells us, but there might be some question of too many carbohydrates and too little protein. VS are normal, glucose was WNL (one time for each of these). Made us think of DM - high carbs cause release of too much insulin, which causes low sugar and hunger and craving for protein, which he says he has said craving.