A 45-year-old man with alcohol dependence is admitted for detoxification. On day 3, he develops confusion, ophthalmoplegia, ataxia, and peripheral neuropathy. He has been receiving glucose infusions. What is the immediate treatment?
- A Oral thiamine 100 mg/day after completing glucose drip
- B Pyridoxine 100 mg IV stat and folate supplementation
- C IV thiamine 500 mg TDS before any further glucose, followed by oral thiamine ✓
- D Magnesium sulphate IV followed by oral multivitamins
Explanation
This is Wernicke's Encephalopathy (WE) — the triad of ophthalmoplegia, ataxia, and confusion in an alcoholic. Glucose administration without thiamine precipitates WE by depleting residual thiamine reserves (thiamine is a cofactor for pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase). Treatment requires high-dose parenteral thiamine (500 mg IV TDS for 3 days per UK guidelines/Pabrinex protocol) BEFORE glucose. Oral thiamine has poor absorption in alcoholics. Magnesium is also corrected but is not the primary treatment. Failure to treat leads to irreversible Korsakoff psychosis.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.