Fatigue

Chapter 13 FATIGUE

Theodore O’Connell

Fatigue is defined as a subjective state of sustained lack of energy or exhaustion with a decreased capacity for physical and mental work, which persists despite sufficient rest. Fatigue is one of the most common complaints in adults presenting for primary care in the United States and must be differentiated from weakness or exertional difficulties.

Acute viral syndromes are a common cause of fatigue and are usually self-limited. Fatigue that persists longer than 1 month generally warrants investigation. Although fatigue is usually the symptom of which the patient complains, careful history documentation often reveals associated symptoms. A targeted physical examination may lead to additional diagnostic clues. A laboratory examination may not be required in all cases of fatigue, but targeted testing may help the clinician pinpoint the cause of the patient’s symptoms.

Depression is the most common cause of clinically important fatigue in patients presenting for primary care. Fatigue is common in the elderly population and may represent part of the normal aging process. However, fatigue should not be attributed to advanced age alone. Rather, fatigue as a consequence of advanced age should be a diagnosis of exclusion.

Medications Associated with Fatigue

Almost every medication may cause fatigue and should be considered in the evaluation of the patient with fatigue. The following categories of medications are more common causes of fatigue.

Benzodiazepines

Blood pressure medications

Glucocorticoids

Narcotic pain medications

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Selective serotonin reuptake inhibitors

Sleeping medications

Tricyclic antidepressants

Causes of Fatigue

Addison disease

Allergic rhinitis

Anorexia nervosa

Bipolar disorder

Bulimia nervosa

Carbon monoxide poisoning

Chronic pulmonary disease

Chronic sinusitis

Coccidioidomycosis

Cushing disease

Cytomegalovirus infection

Dermatomyositis

Epstein-Barr virus infection

Heavy metal exposure

Helminth infestation

Hepatitis B or C

Hyperthyroidism

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