Fatigue

Fatigue
ICD-10	R53
ICD-9	780.7
DiseasesDB	30079
MedlinePlus	003088
MeSH	D005221

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles. It can be both physical and mental. Physical fatigue is the inability to continue functioning at the level of one's normal abilities. It is ubiquitous in everyday life, but usually becomes particularly noticeable during heavy exercise. Mental fatigue, on the other hand, rather manifests in somnolence.

Types

Physical fatigue

Main article: Muscle weakness

Physical fatigue or muscle weakness (or "lack of strength") is a direct term for the inability to exert force with ones muscles to the degree that would be expected given the individual's general physical fitness. A test of strength is often used during a diagnosis of a muscular disorder before the etiology can be identified. Such etiology depends on the type of muscle weakness, which can be true or perceived as well as central or peripheral. True weakness is substantial, while perceived rather is a sensation of having to put more effort to do the same task. On the other hand, central muscle weakness is an overall exhaustion of the whole body, while peripheral weakness is an exhaustion of individual muscles.

Mental fatigue

Template:Seealso In addition to physical, fatigue also includes mental fatigue, not necessarily including any muscle fatigue. Such a mental fatigue, in turn, can manifest itself both as somnolence (decreased wakefulness) or just as a general decrease of attention, not necessarily including sleepiness. In any case, this can be dangerous when performing tasks that require constant concentration, such as driving a vehicle. For instance, when a person is sufficiently somnolent, he or she may experience microsleeps. However, objective cognitive testing should be done to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness.

Causes

Fatigue is typically the result of working, mental stress, jet lag or active recreation, depression, and also boredom, disease and lack of sleep. It may also have chemical causes, such as poisoning or mineral or vitamin deficiencies.

The sense of fatigue is believed to originate in the reticular activating system of the lower brain. Musculoskeletal structures may have co-evolved with appropriate brain structures so that the complete unit functions together in a constructive and adaptive fashion. The entire systems of muscles, joints, and proprioceptive and kinesthetic functions plus parts of the brain evolve and function together in a unitary way.

Diseases

Temporary fatigue is likely to be e.g. common cold. Chronic fatigue, on the other hand, meaning of six months or more duration, is a symptom of a large number of different diseases on conditions.

Medications

• Beta blocker medication causes fatigue, especially after exertion, inducing exercise intolerance.

Laboratory Findings

• Complete blood count (CBC)
• Chemistries
• Calcium
• Urinalysis
• Glucose
• Thyroid stimulating hormone
• Liver function tests
• Stool guaiac
• Screening for chronic infection, malignancy, cardiopulmonary disease and psychiatric disease
• Age-appropriate cancer screening
• Pregnancy test
• Appropriate cultures and/or serolgy
• Lyme titers
• Hepatitis workup
• Anemia workup
• Thyroid function tests

Differential Diagnosis of Causes of Fatigue

(In alphabetical order)

1,3-Dichloropropene 5-MeO-AMT Accessory pancreas Aciclovir Acute bronchitis Acute Hepatitis Acute lymphoblastic leukemia Acute myeloid leukemia Acute prostatitis Acute viral nasopharyngitis (common cold) Adderall Addison's disease Adiposis dolorosa Adrenal metastases African Trypanosomiasis AIDS Airsickness Aldesleukin Altitude sickness Altretamine Amikacin Sulfate Injection Amiloride and Hydrochlorothiazide Andropause Anemia Angina pectoris Ankylosing spondylitis Anorexia Nervosa Anxiety disorder Arnold-Chiari malformation Ascites Atrial fibrillation Auranofin Autoimmune disease Azelastine Azotemia B12 Deficiency Bacterial pneumonia Barbiturate Barth syndrome Becker's muscular dystrophy Benign fasciculation syndrome Beta-blockers Bezafibrate Bipolar disorder Blastocystosis Blood transfusion Botulism Brain abscess Bromopride Bulimia nervosa Busulfan Cadmium Cancer Syndrome Carbon monoxide poisoning Carboplatin Cardiac amyloidosis Cardiogenic shock Carmustine Celiac disease Cerebrovascular arteriosclerosis Cerivastatin Cervical cancer Chlorambucil Chloropyramine Cholesterol pericarditis Chronic bronchitis Chronic Fatigue Syndrome Chronic inflammatory demyelinating polyneuropathy Chronic kidney disease Chronic Liver Disease Chronic mountain sickness Chronic myelogenous leukemia Chronic obstructive pulmonary disease Chronic pancreatitis Chronic pyelonephritis Chronic renal failure Ciguatera Cirrhosis Citalopram Citrulline Citrus Cladosporium Cladribine Clinical depression Clobenzorex Clomipramine Clonidine Coccidioidomycosis Cogan syndrome Congenital Heart Disease Congestive Heart Failure Connective Tissue Disease Conn's Syndrome Constrictive pericarditis Conversion disorder Coronary Artery Disease Coronary Artery Fistula Crohn's disease Cushing's Disease Cytarabine Da Costa's syndrome Dacarbazine Dantrolene Oral

Daunorubicin Decompression sickness Dehydration Delavirdine Depo-Provera Diabetes mellitus Diabulimia Diborane Dientamoebiasis Diflunisal Diphtheria Dobutamine Hydrochloride Injection Docetaxel Double Outlet Right Ventricle Doxepin Doxorubicin Duchenne muscular dystrophy Duloxetine Ebola hemorrhagic fever Emergency contraception Emotional exhaustion Emphysema Empty sella syndrome Encephalomyelitis Endometriosis Engelmann syndrome Entamoeba histolytica Enterovirus Epidermolysis bullosa dystrophica Epstein-Barr virus Erysipelas Ethylene Etoposide Oral and Injection Evans syndrome Exertion Ezetimibe/simvastatin Fabry's disease Fairbanks disease Fenofibrate fever Fibromyalgia Floxuridine Fluconazole Injection Fludarabine Phosphate Fluorouracil Fungemia Gastric dumping syndrome Gastric lymphoma Gastroenteritis Gastrointestinal bleeding (GI) Gaucher's disease Gemcitabine Hydrochloride Generalized anxiety disorder Gentamicin Sulfate Injection Gestational diabetes Giant Cell Arteritis Gitelman syndrome Graves' Disease Grifulvin V Griseofulvin Guanfacine Gulf War syndrome H1 antihistamine Hairy cell leukemia Hangover Hantavirus pulmonary syndrome Hashimoto's thyroiditis Hay fever Helicobacter pylori infection Hemochromatosis Hemolytic anemia Hemorrhagic fever with renal syndrome Hepatitis A Hepatitis C Hereditary elliptocytosis Hereditary spherocytosis Herpes simplex virus HIV Hodgkin's lymphoma Hookworm Hydrogen sulfide Hyperaldosteronism Hypercalcemia Hyperglycemia Hypermobility Hyperparathyroidism Hypertensive heart disease Hyperthyroidism Hypertrophic cardiomyopathy Hypervitaminosis D Hypocalcemia Hypoglycemia Hypogonadism Hypokalemia Hypopituitarism Hypotension Hypothyroidism Idarubicin Ifosfamide Inappropriate sinus tachycardia Indapamide Infectious mononucleosis Infective endocarditis Inflammatory Bowel Disease

Influenza Interferon Alfa-2a and Alfa-2b Injection Interferon Gamma-1b Injection Interstitial nephritis Irritable bowel syndrome Itraconazole Kikuchi disease Labetalol Lamivudine Lamotrigine Lassa fever Lead poisoning Leukemia Levocetirizine Lomustine Loperamide Low-carbohydrate diet Lower respiratory tract infection Lung cancer Lyme disease Lymphoma Major Depression Malignancy Maprotiline Marburg hemorrhagic fever Marfan syndrome Mechlorethamine Megaloblastic Anemias Meloxicam Melphalan Mercaptopurine Meropenem Injection Mesna Mesothelioma Metal fume fever Methemoglobinemia Methotrexate Injection Metoclopramide Hydrochloride Injection Mifepristone Migraine Milk-alkali syndrome Mitomycin Mitral Stenosis Mitral valve prolapse Molybdenum Monocrotophos Motion sickness Moxonidine Multiple endocrine neoplasia type 1 Multiple endocrine neoplasia type 2 Multiple myeloma Multiple sclerosis Mushroom poisoning Myasthenia gravis Mycobacterium avium complex infection Mycophenolic acid Myelodysplastic Syndrome Myleofibrosis Myoadenylate deaminase deficiency Myocardial infarction Myofascial pain syndrome Nadolol Naphthalene Nebivolol Neisseria meningitidis Neuroblastoma Neuroglycopenia Neuromuscular weakness Nitrazepam Non-24-hour sleep-wake syndrome Noncompaction cardiomyopathy Non-Hodgkin lymphoma Osteitis fibrosa cystica Osteomalacia Osteomyelitis Ovarian cancer Ovarian cyst Oxaliplatin Oxcarbazepine Paclitaxel Panniculitis Pantothenic acid Parkinson's disease Pegaspargase Pentamidine Inhalation Pentostatin Pericardial constriction Perimenopause Perindopril Pernicious anemia Phenelzine Phlegmon Pityriasis rosea Plicamycin Pneumonia Polyarteritis nodosa Polycystic kidney disease Polycythemia Vera Polymyalgia Rheumatica Polymyositis Post-concussion syndrome Postnatal depression Post-polio syndrome Postural orthostatic tachycardia syndrome

Post-viral fatigue syndrome Praziquantel Pregnancy Premenstrual syndrome Primary biliary cirrhosis Procarbazine Promethazine Pseudomembranous colitis Psychosomatic illness Pulmonary hypertension Pure autonomic failure Pyruvate carboxylase deficiency Quinapril Quinidine Oral Radafaxine Radiation poisoning Reactive hypoglycemia Reserpine Respiratory acidosis Respiratory failure Rhinovirus Rifabutin Right Ventricular Outflow Tract Obstruction Rilmenidine Rizatriptan Ross River Fever Sarcoidosis Sargramostim injection Satratoxin-H Scarlet fever Schistosomiasis Sheehan's Syndrome Shock (medical) Short bowel syndrome Sick building syndrome Sick sinus syndrome Sickle-cell disease Silicosis Sinusitis Sjogren's Syndrome Sleep deprivation Sleep disorder Sleeping sickness SSRI discontinuation syndrome ST Elevation Myocardial Infarction Symptoms Starvation Still's disease Stomach cancer Streptozocin Stress (medicine) Subacute bacterial endocarditis Syphillis Systemic lupus erythematosus Takayasu's arteritis Temozolomide Teniposide Terazosin Thalidomide Thiabendazole thiazide Thioguanine Thiotepa Thrombotic Thrombocytopenic Purpura Tinidazole Tobramycin Sulfate Injection Tolosa-Hunt syndrome Topiramate Topotecan Hydrochloride Torsemide Injection Torsemide Oral Tralomethrin Trandolapril Trastuzumab Trazodone Trepanation Trestolone Tricuspid Regurgitation Trifascicular block Trimetrexate Glucuronate Trovafloxacin Tuberculosis Tularemia Ulcerative colitis Upper Airway Resistance Syndrome (UARS) Urinary tract infection Valaciclovir Valproic acid Valvular Heart Disease Venlafaxine Ventricular Septal Defect Vicodin Vigabatrin Vinblastine Vinorelbine Tartrate Viral Hemorrhagic Fever Vitamin C megadosage Wegener's granulomatosis Wolff-Parkinson-White Syndrome Zalcitabine Zidovudine Injection Zileuton Zoledronate Zopiclone

Complete Differential Diagnosis of the Causes of ...

(By organ system)

Cardiovascular	Angina pectoris, Atrial fibrillation, Cardiac amyloidosis, Cardiogenic shock, Cerebrovascular arteriosclerosis, Cholesterol pericarditis, Congenital Heart Disease, Congestive Heart Failure, Constrictive pericarditis, Coronary Artery Disease, Coronary Artery Fistula, Double Outlet Right Ventricle, Giant Cell Arteritis, Hypertensive heart disease, Hypertrophic cardiomyopathy, Hypotension, Inappropriate sinus tachycardia, Infective endocarditis, Mitral Stenosis, Mitral valve prolapse, Myocardial infarction, Pericardial constriction, Postural orthostatic tachycardia syndrome, Right Ventricular Outflow Tract Obstruction, Sick sinus syndrome, Subacute bacterial endocarditis, Tricuspid Regurgitation, Trifascicular block, Ventricular Septal Defect, Wolff-Parkinson-White Syndrome,
Chemical / poisoning	Cadmium, Carbon monoxide poisoning, Ciguatera, Naphthalene, 1,3-Dichloropropene, Ethylene, Lead poisoning, Metal fume fever, Monocrotophos, Silicosis,
Dermatologic	Erysipelas, Pityriasis rosea,
Drug Side Effect	Aciclovir, Adderall, Aldesleukin , Altretamine , Amikacin Sulfate Injection , Amiloride and Hydrochlorothiazide , Auranofin , Azelastine, Bezafibrate, Bromopride, Busulfan , Carboplatin , Carmustine , Cerivastatin , Chlorambucil , Chloropyramine, Citalopram, Citrulline, Cladribine , Clobenzorex, Clomipramine, Clonidine, Dacarbazine , Dantrolene Oral , Daunorubicin , Delavirdine, Depo-Provera, Diborane, Diflunisal, Dobutamine Hydrochloride Injection , Docetaxel , Doxepin, Doxorubicin , Duloxetine, Etoposide, Ezetimibe/simvastatin, Fenofibrate , Floxuridine , Fluconazole Injection , Fludarabine Phosphate , Fluorouracil , Gemcitabine Hydrochloride , Gentamicin Sulfate Injection , Grifulvin V, Griseofulvin , Guanfacine, H1 antihistamine, Idarubicin , Ifosfamide , Indapamide, Interferon Alfa-2a and Alfa-2b Injection , Interferon Gamma-1b Injection , Itraconazole, Labetalol, Lamivudine , Lamotrigine, Levocetirizine, Lomustine , Loperamide, Maprotiline, Mechlorethamine , Meloxicam, Mercaptopurine , Meropenem Injection , Methotrexate Injection , Metoclopramide Hydrochloride Injection , Mifepristone, Mitomycin , Molybdenum, Moxonidine, Mycophenolic acid, Nadolol, Nebivolol, Nitrazepam, Oxaliplatin, Oxcarbazepine, Paclitaxel , Pantothenic acid, Pegaspargase , Pentamidine Inhalation , Pentostatin , Perindopril, Phenelzine, Plicamycin , Praziquantel, Procarbazine , Promethazine, Quinapril, Quinidine Oral , Radafaxine, Reserpine, Rifabutin , Rilmenidine, Rizatriptan , Sargramostim injection , Streptozocin , Temozolomide , Teniposide , Terazosin, Thalidomide, Thiabendazole, thiazide, Thioguanine , Thiotepa , Tinidazole, Tobramycin Sulfate Injection , Topotecan Hydrochloride , Torsemide Injection , Torsemide Oral , Tralomethrin, Trandolapril, Trastuzumab , Trazodone, Trepanation, Trestolone, Trimetrexate Glucuronate , Trovafloxacin , Valaciclovir, Valproic acid, Venlafaxine, Vicodin, Vigabatrin, Vinblastine , Vinorelbine Tartrate , Zalcitabine , Zidovudine Injection , Zileuton , Zoledronate, Zopiclone,
Ear Nose Throat	Acute viral nasopharyngitis (common cold), Sinusitis,
Endocrine	Addison's disease, Conn's Syndrome, Cushing's Disease, Diabetes mellitus, Empty sella syndrome, Graves' Disease, Hashimoto's thyroiditis, Hyperparathyroidism, Hyperthyroidism, Hypogonadism, Hypopituitarism, Hypothyroidism,
Environmental	No underlying causes
Gastroenterologic	Accessory pancreas, Ascites, Celiac disease, Chronic Liver Disease, Chronic pancreatitis, Cirrhosis, Crohn's disease, Gastric dumping syndrome, Gastric lymphoma, Gastroenteritis, Gastrointestinal bleeding, Hepatitis A, Hepatitis C, Inflammatory Bowel Disease, Irritable bowel syndrome, Pseudomembranous colitis, Ulcerative colitis,
Genetic	Barth syndrome, Becker's muscular dystrophy, Engelmann syndrome, Epidermolysis bullosa dystrophica, Fabry's disease, Fairbanks disease, Marfan syndrome, Myoadenylate deaminase deficiency,
Hematologic	Acute lymphoblastic leukemia, Acute myeloid leukemia, Anemia, Chronic myelogenous leukemia, Fungemia, Hairy cell leukemia, Hemochromatosis, Hemolytic anemia, Hereditary elliptocytosis, Hereditary spherocytosis, Leukemia, Megaloblastic Anemias, Methemoglobinemia, Polycythemia Vera, Sickle-cell disease,
Iatrogenic	Blood transfusion, Radiation poisoning, Short bowel syndrome,
Infectious Disease	African Trypanosomiasis, AIDS, Bacterial pneumonia, Blastocystosis, Botulism, Coccidioidomycosis, Dientamoebiasis, Diphtheria, Ebola hemorrhagic fever, Entamoeba histolytica, Enterovirus, Epstein-Barr virus, Hantavirus pulmonary syndrome, Helicobacter pylori infection, Herpes simplex virus, HIV, Hookworm, Infectious mononucleosis, Influenza, Lassa fever, Lyme disease, Marburg hemorrhagic fever, Mycobacterium avium complex infection, Neisseria meningitidis, Post-polio syndrome, Post-viral fatigue syndrome, Rhinovirus, Schistosomiasis, Syphillis, Tuberculosis, Tularemia, Viral Hemorrhagic Fever,
Musculoskeletal / Ortho	Ankylosing spondylitis, Duchenne muscular dystrophy, Fairbanks disease, Osteitis fibrosa cystica, Osteomalacia, Osteomyelitis, Polymyalgia Rheumatica, Pregnancy, Still's disease,
Neurologic	Arnold-Chiari malformation, Benign fasciculation syndrome, Bipolar disorder, Brain abscess, Chronic inflammatory demyelinating polyneuropathy, Encephalomyelitis, Migraine, Multiple sclerosis, Neuroglycopenia, Neuromuscular weakness, Parkinson's disease, Post-concussion syndrome,
Nutritional / Metabolic	B12 Deficiency, Gaucher's disease, Low-carbohydrate diet, Milk-alkali syndrome, Mushroom poisoning, Pernicious anemia, Pyruvate carboxylase deficiency, Vitamin C megadosage,
Obstetric/Gynecologic	Cervical cancer, Endometriosis, Gestational diabetes, Ovarian cancer, Ovarian cyst, Perimenopause, Sheehan's Syndrome,
Oncologic	Adrenal metastases, Cancer Syndrome, Hodgkin's lymphoma, Mesothelioma, Multiple endocrine neoplasia type 1, Multiple endocrine neoplasia type 2, Multiple myeloma, Myelodysplastic Syndrome, Myleofibrosis, Neuroblastoma,
Opthalmologic	Cogan syndrome, Tolosa-Hunt syndrome,
Overdose / Toxicity	Barbiturate, Hydrogen sulfide, Hypervitaminosis D, Satratoxin-H,
Psychiatric	Anorexia Nervosa, Anxiety disorder, Bulimia nervosa, Clinical depression, Conversion disorder, Da Costa's syndrome, Diabulimia, Major Depression, Postnatal depression, Psychosomatic illness, Sick building syndrome,
Pulmonary	Bronchitis, Chronic obstructive pulmonary disease, Emphysema, Lower respiratory tract infection, Lung cancer, Pneumonia, Pulmonary hypertension, Respiratory acidosis, Upper Airway Resistance Syndrome (UARS),
Renal / Electrolyte	Azotemia, Chronic kidney disease, Chronic pyelonephritis, Chronic renal failure, Gitelman syndrome, Hemorrhagic fever with renal syndrome, Hypercalcemia, Hypocalcemia, Hypokalemia, Interstitial nephritis, Polycystic kidney disease, Urinary tract infection,
Rheum / Immune / Allergy	Evans syndrome, Hay fever, Myasthenia gravis, Panniculitis, Phlegmon, Polyarteritis nodosa, Polymyositis, Primary biliary cirrhosis, Sarcoidosis, Sjogren's Syndrome, Systemic lupus erythematosus, Takayasu's arteritis, Wegener's granulomatosis,
Sexual	Acute prostatitis, Andropause,
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Adiposis dolorosa, Airsickness, Altitude sickness, Chronic Fatigue Syndrome, Chronic mountain sickness, Decompression sickness, Dehydration, Exertion, fever, Fibromyalgia, Hangover, Hyperglycemia, Hypermobility, Hypoglycemia, Kikuchi disease, Motion sickness, Myofascial pain syndrome, Reactive hypoglycemia, Sleep deprivation, Sleep disorder, Sleeping sickness, SSRI discontinuation syndrome,

Treatment

• Treatment of underlying medical etiologies
• Discontinue (or switch) harmful/aggravating medications
• Schedule regular physical activity
• Improvement of sleep hygiene
• Cognitive behavioral psychiatric therapy
• Referral to possible support groups
• Weight loss (for obesity)
• Supportive care, healthy diet, moderate exercise (chronic fatigue syndrome and fibromyalgia)

See also

• Somnolence
• Insomnia
• Combat stress reaction (Battle fatigue)
• Malaise
• Asthenia
• Paresis
• Debility
• Muscle weakness
• Muscle fatigue
• Infectious mononucleosis
• Celiac disease (gluten sensitivity)

Pharmacotherapy

Acute Pharmacotherapies

• Antidepressants

External links

• National Cancer Institute

Acknowledgements

The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]

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