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WEAKNESS and/or TIREDNESSRecognise the patient with weakness and/or tiredness needing urgent attention:• Possible stroke or TIA: sudden onset of weakness on 1 or both sides perhaps with vision problems, dizziness, difficulty speaking or swallowing 76.• Difficulty breathing 16.• Chest pain 15.• Patient on ART with other signs of lactic acidosis: nausea, abdominal pain or swelling, weight loss, fatigue, shortness of breath 63.• Diarrhoea and/or vomiting with reliable signs of dehydration:--Postural hypotension (systolic BP drop > 20mmHg between lying and standing)--Poor urine output--ConfusionManagement:• If dehydrated give oral or IV rehydration. Reassess after 2 hours and refer if no improvement.Approach to patient with weakness and/or tiredness not needing urgent attention:• Tiredness is a problem when it persists so that the patient is unable to complete routine tasks and it disrupts work, social and family life.• Look for a cause of the patient’s weakness/tiredness:• If ≥ 38ºC 4.First check patient’s temperature.Then exclude TB, HIV, pregnancy and stress.• Ask about TB symptoms. Exclude TB 55.• If status unknown, test for HIV 60. The HIV patient needs routine HIV care 61.• Exclude pregnancy. If pregnant 93.• Ask ‘Are you stressed?’ If yes 52.• If patient has difficulty sleeping 54.If none of the above, test for anaemia, diabetes, kidney and thyroid disease.• Check Hb for anaemia: if < 11 (woman) or < 12 (man), refer to doctor same week.• Exclude diabetes with random finger prick blood glucose. To interpret result 70.• Look for kidney disease on urine dipstick: check eGFR if patient has proteinuria, diabetes, hypertension, or is > 60 years.• Check TSH if any of weight gain, dry skin, constipation, cold intolerance. If TSH abnormal refer to doctor.Refer the patient with persistent weakness/tiredness and no obvious cause.6TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERSWOMEN'S HEALTH