A 50-year-old alcoholic man is brought with confusion, bilateral horizontal gaze palsy, and ataxia. He is malnourished. Which is the most appropriate immediate treatment?
- A Intravenous glucose 50%
- B Intravenous thiamine ✓
- C Intravenous lorazepam
- D Intravenous naloxone
Correct answer: B. Intravenous thiamine
Explanation
The triad of confusion, ophthalmoplegia, and ataxia in a malnourished alcoholic is Wernicke encephalopathy due to thiamine deficiency. Immediate IV thiamine must be given before glucose, as glucose metabolism can precipitate or worsen Wernicke in a thiamine-deficient patient. Lorazepam is for seizures. Naloxone is for opioid overdose.
Reference: Adams and Victor's Principles of Neurology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.