Fatigue

What is Fatigue?

Fatigue is the lack of energy and motivation (both physical and mental). It can be a normal response to physical and mental activity. In most cases it is quickly relieved, usually in hours to about a day, depending on the intensity of the activity, by reducing the activity.

Fatigue is a very common complaint and is a symptom and not a disease. It usually has a gradual onset and the person is unaware of how much energy they have lost until they try to compare their ability to complete tasks from one time frame to another.

Individuals with fatigue may have three primary complaints which varies in each case:

1. Lack of motivation or the ability to begin an activity.
2. Getting tired easily once the activity has begun.
3. Mental fatigue or difficulty with concentration and memory to start or complete an activity.

Chronic fatigue syndrome, also called myalgic encephalomyelitis, is a complex multisystem disease characterized by severe fatigue, cognitive dysfunction, sleep problems, autonomic dysfunction as well as post-exertional malaise, severely impairing activities of daily living. It comprises of the following 2 criteria as stated by Centers for Disease Control and Prevention:

1. Severe chronic fatigue for at least six months or longer with other known medical conditions (whose manifestation includes fatigue) excluded by clinical diagnosis.
2. Concurrently have four or more of the following symptoms:
   • Post-exertional malaise
   • Impaired memory or concentration
   • Unrefreshing sleep
   • Muscle pain
   • Multi-joint pain without redness or swelling
   • Tender cervical or axillary lymph nodes
   • Sore throat
   • Headache

Causes

There are numerous possible causes of fatigue, the most common causes include:

• Metabolic - anemia, hypothyroidism, diabetes, electrolyte abnormalities, kidney diseases, liver diseases, Cushing's disease.
• Infectious - infectious mononucleosis, hepatitis, cytomegalovirus, influenza, malaria and many other infectious diseases.
• Cardiopulmonary - congestive heart failure, coronary artery disease, valvular heart disease, COPD, asthma, arrhythmias and pneumonia.
• Medications - antidepressants, anti-anxiety medications, sedative medications, medication and drug withdrawal, antihistamines, steroids, etc.
• Psychiatric - depression, anxiety, drug abuse, alcohol abuse, eating disorders, grief and bereavement.
• Sleep problems - sleep apnoea, reflux esophagitis, insomnia, narcolepsy, shift work or work shift changes, Extra night hours at "work"
• Deficiencies - vitamin B12, vitamin D, folic acid and iron deficiency.
• Others - cancer, rheumatological disorders like RA, SLE, fibromyalgia, obesity, chemotherapy and radiation therapy.

Signs and Symptoms

Fatigue is described from feeling weak to being constantly tired or lacking energy.

There may be other associated symptoms depending upon the underlying cause:

• Associated shortness of breath or tiring easily with minimal activity due to an underlying cardiopulmonary disease or anaemia.
• Polyuria (excess urination), polydipsia, or change of vision in diabetic patients.
• Feeling of coldness, dry skin and brittle hair in hypothyroidism.

Diagnosis

The diagnosis is mainly based on the clinical presentation and history. There may be associated symptoms along with fatigue which helps to determine the underlying cause. A proper physical and systemic examination is done and certain laboratory tests may also be advised depending on the findings.

Management

The treatment depends upon the underlying causative condition. An early recognition of fatigue is essential to allow an early diagnosis of the underlying cause.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.