Fatigue

Basics

Description

  • A subjective state of overwhelming, sustained exhaustion, and decreased capacity for physical and mental work that is not relieved by rest
  • Fatigue occurs with or without objective findings on physical exam
  • Fatigue is a common complaint in people with and without systemic disease, which makes this complaint a challenge to practicing physicians
  • High levels of fatigue are associated with excess mortality in the general population

Etiology

  • The specific mechanisms of fatigue are unknown
  • Hematologic:
    • Anemia
    • Leukemia
  • Endocrine:
    • Thyroid disorders
    • Adrenal insufficiency
    • Diabetes
    • Pregnancy
  • Malignancy:
    • Paraneoplastic syndromes
  • Psychiatric:
    • Chronic pain
    • Emotional distress
    • Depression
    • Eating disorders
    • Chemical dependency
    • Withdrawal syndromes
  • Sleep disorders:
    • Insomnia
    • Sleep apnea
  • Cardiac and pulmonary disorders
  • Infections acute and chronic
  • Rheumatic and autoimmune disorders
  • Nutritional deficiencies including electrolyte abnormalities
  • Physical inactivity and deconditioning
  • Medications
  • Chronic fatigue syndrome:
    • Symptom complex defined by the CDC
    • Severe chronic fatigue lasting >6 mo
    • Not explained by any medical or psychiatric diagnosis
    • Presence of 4 or more of the following 8 symptoms:
      • Headache
      • Arthralgias
      • Sleep disturbances
      • Lymphadenopathy
      • Exercise intolerance
      • Myalgias
      • Impaired memory/concentration
      • Sore throat

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