A 55-year-old man with chronic alcoholism presents with confusion, ataxia, and ophthalmoplegia (nystagmus and lateral gaze palsy). He is malnourished. Immediate administration of which substance is MOST likely to reverse these neurological deficits?
- A Thiamine ✓
- B Naloxone
- C Fomepizole
- D Flumazenil
Correct answer: A. Thiamine
Explanation
Wernicke's encephalopathy presents with the classic triad of confusion, ataxia, and ophthalmoplegia, caused by thiamine (vitamin A1) deficiency, common in chronic alcoholics. Thiamine should be administered immediately before glucose, as glucose metabolism can further deplete thiamine and worsen the condition. Naloxone reverses opioids. Fomepizole is for toxic alcohols. Flumazenil reverses benzodiazepines but is contraindicated in mixed overdoses.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.