A 28-year-old woman, 10 weeks pregnant, is admitted with severe hyperemesis gravidarum. She has lost 6 kg over 3 weeks. On examination, she has nystagmus, bilateral lateral rectus palsy, and gait ataxia. She is confused and disoriented. What is the most urgent treatment to prevent permanent memory impairment?

• A Intravenous normal saline
• B Intravenous thiamine ✓
• C Oral vitamin B12
• D Intravenous glucose

Explanation

The triad of ophthalmoplegia, ataxia, and confusion indicates Wernicke encephalopathy due to thiamine deficiency, a known complication of hyperemesis gravidarum. Immediate intravenous thiamine is required to prevent progression to Korsakoff syndrome, which features irreversible anterograde amnesia and confabulation. Administering intravenous glucose without thiamine can precipitate or worsen Wernicke encephalopathy by further depleting thiamine stores.

Reference: Harrison's Principles of Internal Medicine, 20th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.