Fatigue
Fatigue is extremely common. It is often due to life's difficulties and attending psychological effects, but also accompanies a wide variety of diseases. This makes diagnosis quite challenging.
Fatigue prevalance rates range from 6-32% (Godwin et al 1999) and is the presenting problem in 5-10% of primary care visits (Krienke and Mangelsdorff, 1989).
Causes of fatigue
(Ebell and Belden, 2001) reported that, for 100 people presenting with fatigue:
- 25 will be depressed
- 25 will have another psychiatric diagnosis such as anxiety or dysthymia
- 15 will have an infection (postviral, hepititis, mononucleosis, TB, fungal, parasitic, HIV, etc)
- 15 will have a condition such as diabetes, anemia, or hypothyroidism
- another 20 will remain undiagnosed.
Less than 5% of people with fatige have chronic fatigue syndrome.
Other contributing factors include problems with sleep, lack of adequate exercise, too much work, stress, or busyness, with inadequate play, replantishment, or spiritual reflection or renewal.
Investigations
- History
- Physical Exam
- Lab investigations
History
Consider red flags: fever, recent accident, overwork, viral infection, weight loss, night sweats, ill-appearing
overwhelming weakness may suggest electrolyte disorder, hypoglycemia, or neuromuscular disease.
A sleep history can help diagnose insomnia, apnea, or movement disorder.
lab investigations
Investigations include:
- hemoglobin, fasting blood sugar, and thyroid stimulating hormone (TSH).
Workup for advanced autoimmune disorders or chronic infections can also be done.
Transferrin saturation can diagnose hemochromatosis.
Management of Fatigue
While ruling out primary causes of fatigue, let the patient know that there is a 50% chance of a mental health cause and a 8-25% chance of physiological cause. Accordingly, reassurance is perhaps the best treatment.
Some helpful tips to assisting people include:
Beginning a graded exercise program
changing cognitive automatic thoughts: "I am so tired; something must be terribly wrong" to "I am so tired, but they've checked out the badness and I'm going to try to remain positive"
Detect and treat mental illness. Seek a balanced life.
Be patient-centered
Review all medications, watching out for drug-rug interactions and side-effects
Resources and References
Ebell M, Belden JL. 2001. What is... Journal of Family Practice 50:16-17.