Fatigue

Addisonian CRISIS: hypotension/shock, vomiting, hyponatraemia, hypoglycaemia, often triggered by illness/surgery → emerg

Iron-deficiency anaemia in an adult (especially post-menopausal women / any man) → investigate for GI malignancy (urgent

Acute liver failure presentation (coagulopathy/encephalopathy) → urgent specialist

Persistent/vertical/non-fatiguing nystagmus or other neurology → central cause (posterior fossa) → image

Refractory symptoms despite a gluten-free diet, or new alarm features → re-evaluate (adherence, refractory coeliac, lymp

2-week-wait referral: age ≥40 with weight loss + abdominal pain; ≥50 with rectal bleeding; ≥60 with iron-deficiency anae

Marrow failure; transformation to AML; the congenital anomalies are the diagnostic key

Dyspepsia + ALARM features, or age ≥55 with weight loss + upper abdominal pain → urgent (2-week-wait) endoscopy

Cirrhosis → hepatocellular carcinoma risk (surveillance); cardiomyopathy/arrhythmia

Microangiopathic haemolysis with thrombocytopenia (schistocytes) → TTP/HUS/DIC — a haematological emergency (TTP → plasm

Pituitary APOPLEXY (sudden severe headache, visual loss, ophthalmoplegia, hypotension) → emergency (steroids + neurosurg

Myxoedema coma (hypothermia, bradycardia, reduced consciousness, hyponatraemia) → emergency

Iron deficiency in any adult man or post-menopausal woman → urgent investigation for GI cancer (2-week-wait OGD + colono

Hypercalcaemia, acute kidney injury, or metastatic spinal cord compression → emergencies

Any unwell neonate → treat as sepsis until excluded (it can deteriorate fast); meningitis (bulging fontanelle, seizures)

Mesothelioma (asbestos exposure + pleural effusion/chest pain/pleural thickening) → urgent investigation; it is compensa

Progressive dysphagia/weight loss -> exclude oesophageal cancer (endoscopy)

Underlying Addisonian crisis risk; new autoimmune endocrinopathy → screen for the others

Progression to cirrhosis/portal hypertension; HCC risk

Cholangiocarcinoma (rising CA19-9/new dominant stricture); recurrent bacterial cholangitis

Cardiac sarcoid (arrhythmia/heart block), neurosarcoidosis, or sight-threatening uveitis → urgent specialist treatment

Lupus nephritis (proteinuria/active sediment/rising creatinine) → renal biopsy + immunosuppression — determines prognosi

Neutropenic sepsis, bleeding from thrombocytopenia/DIC, or tumour lysis syndrome → emergencies

Haemodynamic instability (shock, syncope, ischaemia, heart failure) → emergency synchronised DC cardioversion

Adverse features (shock, syncope, myocardial ischaemia, heart failure) or risk of asystole (Mobitz II, complete block, r

A rapid fall in eGFR, accelerated hypertension, or visible haematuria → investigate for a treatable cause (GN, obstructi

Neonatal salt-wasting adrenal crisis — hyponatraemia + hyperkalaemia + hypoglycaemia + shock is a medical emergency

Hypoxia / respiratory failure → oxygen + escalation (cross-ref respiratory failure); VTE risk → thromboprophylaxis

Refractory hyperkalaemia/acidosis/fluid overload or uraemic pericarditis/encephalopathy → urgent dialysis (AEIOU)

Red-flag features (weight loss, fever, focal neurology, true weakness, abnormal bloods) → investigate for an alternative