Wernicke Encephalopathy — SCE Neurology MCQ

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EasyNeuropsychiatryWernicke EncephalopathySCE Neurology

A 70-year-old man with a history of alcohol dependence presents with confusion, ophthalmoplegia (lateral rectus palsy bilaterally), and ataxia. What is the first-line treatment that must be given before any glucose administration?

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Correct answer: B — Intravenous Pabrinex (high-potency B vitamins) including thiamine

The triad of confusion, ophthalmoplegia, and ataxia in an alcohol-dependent patient is classic for Wernicke encephalopathy. IV thiamine (as Pabrinex) must be given before glucose administration, as glucose metabolism can deplete thiamine stores and worsen the condition. Oral thiamine is inadequately absorbed in alcoholics. A: Oral thiamine is poorly absorbed. C: Glucose before thiamine risks worsening Wernicke encephalopathy. D: Folic acid does not treat Wernicke encephalopathy. E: Naloxone is for opioid overdose.

Reference: NICE CG100 Alcohol-Use Disorders (2010); BNF