Fatigue

Aka: Fatigue, Asthenia, Fatigue Red Flags

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II. Definitions

  1. Fatigue
    1. Unable to perform activity repeatedly
  2. Asthenia
    1. Physical exhaustion without weakness

III. Types

  1. Secondary Fatigue (20% of non-chornic causes)
    1. Fatigue with underlying medical cause
    2. Fatigue lasts between 1 and 6 months
  2. Physiologic Fatigue (80% of non-chronic causes)
    1. Fatigue due to lifestyle causes
  3. Chronic Fatigue
    1. Fatigue that lasts longer than 6 months
    2. See Chronic Fatigue Syndrome

IV. Causes

  1. Fatigue Causes
  2. See Medication Causes of Fatigue

V. Symptoms

  1. Frequent presentations
    1. "I can't get out of bed in the morning"
    2. "I'm feeling 'all in'"
    3. "I'm tired all the time"
  2. Lack of pep or energy
    1. Usually complaint of "always tired"
    2. However on careful questioning, varies throughout day
  3. Low vitality
  4. Persistent Exhaustion or Tiredness
  5. Strongly desire rest or sleep
  6. Associated symptoms
    1. Subjectively weak
    2. Headache
    3. Assorted pain

VI. Symptoms: Differentiate from Sleepiness

  1. Fatigue is provoked by activity with delayed recovery
    1. Exercise offers a temporary respite from Sleepiness
  2. Nonrestorative rest and sleep
    1. Sleepiness improves with a nap
  3. Poor Muscle endurance and mental exhaustion

VII. Diagnosis: Factors suggestive of psychogenic cause

  1. Fatigue lasting longer than 4 months
    1. No associated signs or symptoms
  2. Fatigue that is worse in morning
    1. Improves with activity
  3. Fluctuating course
  4. Stressful social history
  5. Exhaustive lifestyle
  6. History of psychological condition

VIII. Symptoms: Red Flags (suggestive of organic or physical cause)

  1. Fatigue relieved with rest or sleep
    1. Refreshed in morning
  2. Less than ordinary activity causes Fatigue
  3. Ill appearing, tired or worn patient
  4. Weight loss
  5. Dyspnea

IX. Signs: Red Flags (suggesting Organic Fatigue Causes including neoplasm)

  1. Lymphadenopathy
  2. Cardiac murmur
  3. Thyroid Goiter
  4. Edema
  5. Inflammatory Arthritis findings
  6. Decreased Muscle tone or other focal neurologic deficit
    1. Careful Neurologic Exam is critical

X. Labs

  1. See Fatigue Diagnostic Testing

XI. Management

  1. Daily Exercise (30 minutes of Moderate Aerobic Activity)
  2. Stress reduction
  3. Adequate sleep (8 hours per night)
    1. See Sleep Hygiene
  4. Treat underlying causes of Fatigue
    1. Anemia
    2. Depression

XII. Course

  1. Fatigue may persist for >1 year in 50% of patients

XIII. References

  1. Goroll (2000) Primary Care Medicine, Lippincott, p. 41
  2. Lipken in Dornbrand (1992) Ambulatory Care, p. 5-8
  3. Morrison (2001) Obstet Gynecol Clin North Am 28:225-40 [PubMed]
  4. Rosenthal (2008) Am Fam Physician 78(10): 1173-9 [PubMed]
  5. Valdini (1988) J Fam Pract 26:33-8 [PubMed]

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