Weight loss
Unintentional weight loss is defined as loss of >5% body weight over 6-12 months without trying. In the ED, it is typically a secondary concern raising suspicion for serious underlying pathology.
Differential Diagnosis
Malignancy
- GI cancers (colon, pancreatic, gastric)
- Lung cancer
- Lymphoma
- Any advanced malignancy
GI
- Peptic ulcer disease
- Inflammatory bowel disease
- Celiac disease
- Malabsorption
- Chronic pancreatitis
Endocrine
- Hyperthyroidism
- Diabetes mellitus (uncontrolled)
- Adrenal insufficiency
Infectious
- HIV
- Tuberculosis
- Chronic infection
- Parasitic infection
Psychiatric
- Depression
- Eating disorders
- Substance use
Other
- Heart failure
- COPD
- Renal failure
- Medication side effects
Evaluation
- Focused history: timeline, diet changes, associated symptoms (night sweats, fever, GI symptoms)
- Physical exam: lymphadenopathy, thyroid, abdominal masses, oral lesions
- Basic labs: CBC, BMP, LFTs, TSH, glucose, ESR/CRP, urinalysis
- Consider: HIV test, CXR, age-appropriate cancer screening
- CT abdomen/pelvis if red flags (palpable mass, severe symptoms, elderly)
Management
- ED role is primarily to evaluate for acute dangerous causes
- Treat identified acute conditions
- Outpatient workup appropriate for most stable patients
Disposition
- Admit if acutely ill, severely malnourished, or dangerous etiology identified
- Discharge with urgent PCP follow-up for stable patients with unexplained weight loss
- Ensure cancer screening is up to date