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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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In this Article

• Fatigue Facts
• Fatigue introduction
• What causes fatigue?
• What are the signs and symptoms of fatigue?
• How is the cause of fatigue diagnosed?
• What is the treatment for fatigue?
• Can fatigue be prevented?
• Patient Comments: Fatigue - Causes
• Patient Comments: Fatigue - Symptoms
• Patient Comments: Fatigue - Treatment
• Find a local Doctor in your town
• Fatigue Index

Fatigue is a symptom of an underlying disease and is described in many ways from feeling weak to being constantly tired or lacking energy.

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

• Individuals with heart disease, lung disease, or anemia may complain of associated shortness of breath or tiring easily with minimal activity.
  
  
• Persons with diabetes may complain of polyuria (excess urination), polydypsia (excess thirst), or change of vision.
  
  
• Those who have hypothyroidism may also have symptoms of feeling cold, dry skin and brittle hair.

It is important that the health care practitioner consider the complaint of fatigue in the context of the whole patient to try to come to an accurate causative diagnosis.

The key to finding the cause of fatigue in a patient is the care the health care practitioner takes in compiling a medical history. It is important to ask questions not only about the loss of energy but also about other potential problems that the patient may be experiencing such as shortness of breath, sleep patterns, hair loss, color of the stools, or any of the myriad of questions that might provide information as to what organ system may be involved.

Usually, a history is taken by the health care practitioner asking questions about the quality and quantity of fatigue. Examples of some of the questions the health care practitioner may ask include:

1. Does the patient feel well in the morning when they wake?
   
   
2. Does the fatigue progress through the day?
   
   
3. Does the person nap unexpectedly or take excessive amounts of stimulants such as caffeine to complete daily activities?
   
   
4. Does the fatigue come on gradually or abruptly?
   
   
5. Is it a daily occurrence or intermittent/periodic?
   
   
6. What makes it better and what makes it worse?
   
   
7. How has the patient's life changed because of the fatigue?
   
   
8. Is the fatigue more mental than physical?

Other associated symptoms with fatigue include:

• weight loss,
  
  
• chest pain and shortness of breath,
  
  
• vomiting and diarrhea,
  
  
• fevers and chills,
  
  
• muscle weakness or pain, and/or
  
  
• anxiety and depression.

It is also appropriate for the health care practitioner to ask questions about the patient's social situation and to also ask about their psychologic state of mind. Alcohol and drug abuse screening questions should be expected as routine.

Because fatigue is such a non-specific symptom, each answer may direct the health care practitioner to explore a different potential cause.

A full physical examination is important to look for underlying signs of illness. The general appearance of the patient is important looking for hygiene, vital signs, and evidence of anxiety or agitation. Examination and evaluation of the different systems of the body (heart, lungs, abdomen, neurological system, etc.) and combining any abnormal findings with the clues found in the history taking may help make the diagnosis.

Special attention may be taken to palpate (feel) for an abnormal thyroid gland, swollen lymph nodes,  listen for abnormal heart sounds including murmurs and to check for normal muscle tone and reflexes.

Depending on the findings in the history and physical examination, blood tests and other imaging studies may be ordered. Initial screening blood tests may include:

• CBC (complete blood count that includes a red blood cell, white blood cell and platelet count);
  
  
• electrolytes (sodium potassium, chloride, carbon dioxide, and sometimes calcium and magnesium);
  
  
• glucose (blood sugar);
  
  
• BUN/creatinine (to measure kidney function);
  
  
• TSH or thyroid stimulating hormone;
  
  
• CPK (elevated in illnesses that cause muscle inflammation); and/or
  
  
• ESR or erythrocyte sedimentation rate (non specific blood marker for inflammation in the body).

The decision to obtain X-rays, CT scans, electrocardiogram (ECG, EKG) and other imaging or testing will depend upon the individual patient's circumstances and what the health care practitioner suspects may be the underlying cause of the fatigue.