A 55-year-old man with chronic alcohol dependence is brought confused and unable to walk. He has bilateral lateral rectus palsies, nystagmus, and truncal ataxia. The emergency physician plans fluids and dextrose first. What is the correct immediate management priority?
- A Give glucose alone, then thiamine after imaging
- B Give parenteral thiamine before or together with glucose ✓
- C Give oral thiamine 100 mg once weekly
- D Give magnesium sulphate infusion
Correct answer: B. Give parenteral thiamine before or together with glucose
Explanation
The triad of confusion, ophthalmoplegia, and ataxia indicates Wernicke encephalopathy from thiamine deficiency. High-dose parenteral thiamine must be given immediately, before or alongside any glucose infusion, because administering glucose to a thiamine-depleted brain can precipitate or worsen the encephalopathy. Oral weekly thiamine is inadequate for acute disease, and magnesium corrects refractory hypokalaemia but does not treat the underlying deficiency.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.