General malaise

Specialty: General.

• general indisposition
• decomposed body
• systemic decay
• feeling of being sick
• general breakdown

Why it occurs

• Acute or subacute viral infections (such as infectious mononucleosis due to Epstein-Barr virus, cytomegalovirus, viral hepatitis prodromes, or influenza, in which the cascade of proinflammatory cytokines such as IL-1, IL-6, and TNF-alpha alters thermoregulation and cellular homeostasis)
• Systemic autoimmune and inflammatory diseases (systemic lupus erythematosus, systemic vasculitis or rheumatoid arthritis, where persistent immune-mediated inflammation diffusely affects the body)
• Occult or hematological neoplasms (lymphomas, multiple myeloma or solid carcinomas in early stages that induce a chronic systemic inflammatory state)
• Subclinical endocrine and metabolic disorders (incipient adrenal insufficiency, primary hypothyroidism or mild hypercalcemia that disturb the metabolic balance of the tissues)
• Adverse drug reactions or toxicity (accumulation of metabolites, complex drug interactions in patients with moderate renal or hepatic impairment)

Initial workup

Complete blood count with formula and differential count, erythrocyte sedimentation rate (ESR), ultrasensitive C-reactive protein (CRP), complete metabolic panel (glucose, urea, creatinine, serum electrolytes, liver profile), general urine test with sediment, and TSH.

Standard management

• Paracetamol — 500 mg to 1 g orally every 6 or 8 hours, used as an antipyretic and central analgesic with minimal gastrointestinal impact
• Ibuprofen — 400 mg orally every 8 hours, administered with food, indicated if a concomitant musculoskeletal inflammatory component is suspected
• Oral rehydration serum (in doses of 250 ml after episodes of diaphoresis or low water intake to maintain osmotic stability).