A 42-year-old man with chronic heavy alcohol use is admitted with Wernicke's encephalopathy. Which is the most important IMMEDIATE treatment?

• A Oral thiamine 100 mg daily
• B IV glucose infusion followed by oral vitamins
• C High-dose IV thiamine (Pabrinex) 500 mg three times daily for at least 3 days ✓
• D IM vitamin B12 and folate

Explanation

Wernicke's encephalopathy (acute triad: ophthalmoplegia/nystagmus, ataxia, confusion) is a neurological emergency caused by thiamine (vitamin B1) deficiency. Treatment requires high-dose IV thiamine — the Royal College of Physicians and SIGN guidelines recommend IV thiamine (as Pabrinex) 500 mg (two pairs of high-potency ampoules) three times daily for at least 3 days. Oral thiamine is poorly absorbed in alcoholism and inadequate for acute encephalopathy. Critically, glucose infusion MUST NOT precede thiamine, as glucose administration can precipitate or worsen Wernicke's by depleting the residual thiamine. Untreated, it progresses to Korsakoff's syndrome (irreversible anterograde amnesia with confabulation).

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.