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Tiredness/fatigue in adults - Management
Overview of management

  • Establish a supportive therapeutic relationship, taking the person's complaint seriously and adopting a holistic approach.
  • Try to identify an underlying cause, bearing in mind that tiredness may be caused by one or a combination of physical, psychosocial, and physiological factors, or may be unexplained.
    • Look for any red flags.
    • Consider easily missed conditions, such as Addison's disease, carbon monoxide poisoning, coeliac disease, domestic abuse, haemochromatosis, hypopituitarism, medication, pregnancy, renal failure, and sleep apnoea (see the CKS topics on Carbon monoxide poisoning, and Sleep apnoea).
    • Consider any existing chronic illnesses, psychiatric history, and current or recent infections.
    • Take a history and do a physical examination (see Assessment).
    • Arrange appropriate investigations.
    • Consider the possibility of chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy (CFS/ME).
  • Consider whether referral is indicated.
  • Treat the underlying cause, if this is known.
  • Consider treatment strategies for people with persistent, unexplained fatigue.
  • In women of child-bearing age with a serum ferritin level of 50 micrograms/L or less without anaemia:
    • Identify the cause and consider offering iron supplementation (80 micrograms/day elemental iron) for at least 4 weeks (off-label indication).

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