Definition: Fatigue comprises the subjective, self-reported symptoms of tiredness, exhaustion, lack of energy, and weariness. Important to ask the patient their definition of fatigue.

• Many aetiologies which can be broadly classified into chronic medical disease, psychiatric disease, lifestyle factors, medications, and treatment effects

• Focus of evaluation for fatigue is to identify common underlying causes and any life threatening diseases, such as cancer

• In up to a third of cases, a medical cause cannot be determined

• find out what patient interprets as fatigue - quantify for patient (duration, has it changed, symptoms)

• mental health screening important for fatigue (depression, post natal)

• endocrine screening

• care for cancer

• sleep apnoea

• fatigue on exertion → heart attack waiting to happen in women especially

• chronic fatigue syndrome - autoimmune condition

Red flags Potential serious underlying disease

• Recent onset of fatigue in a previously well older patient
  • Malignancy, Anaemia, Cardiac arrhythmia, CRF, DM, CAD, Hypertension, Endocrine, Hypothyroidism.
• Unintentional weight loss
  • Malignancy, HIV, DM, Hyperthyroidism
• Abnormal bleeding
  • Anaemia. Malignancy
• Shortness of breath
  • Anemia, Heart failure, arrhythmia, COPD.
• lymphadenopathy
  • Malignancy