A 42-year-old chronic alcohol-dependent man is admitted for detoxification. On day 3, he develops confusion, ataxia, and horizontal nystagmus. The most likely diagnosis and the IMMEDIATE treatment is:

• A Alcohol withdrawal delirium; high-dose diazepam IV
• B Korsakoff's psychosis; oral thiamine 100 mg/day long-term
• C Hepatic encephalopathy; lactulose and rifaximin
• D Wernicke's encephalopathy; IV thiamine 500 mg three times daily before any glucose ✓

Explanation

The triad of confusion, ataxia, and ophthalmoplegia/nystagmus is Wernicke's encephalopathy, a thiamine-deficiency emergency. Treatment requires parenteral thiamine (Pabrinex: 500 mg IV TDS for 2–3 days) BEFORE any glucose administration, since glucose infusion in a thiamine-depleted patient can precipitate or worsen Wernicke's. Korsakoff's psychosis is the chronic amnestic sequela; it is not reversible and requires long-term thiamine. Diazepam addresses alcohol withdrawal seizures/DTs, not this triad.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.