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Parenteral vs Oral Thiamine — SCE Neurology MCQ

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HardCNS InfectionsParenteral vs Oral ThiamineSCE Neurology

A man with alcohol dependence is admitted with confusion, gait ataxia and horizontal nystagmus after several days of poor intake. Glucose-containing intravenous fluid is being prepared. What is the most appropriate immediate vitamin strategy?

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Correct answer: D — Give parenteral thiamine before or with carbohydrate replacement and continue active treatment

Confusion, ataxia and nystagmus in a malnourished alcohol-dependent patient should be treated as possible Wernicke encephalopathy. Give parenteral thiamine before or with carbohydrate replacement; oral absorption is unreliable and delayed treatment risks irreversible injury.

Reference: NICE CG100: alcohol-use disorders – physical complications: https://www.nice.org.uk/guidance/cg100/chapter/Recommendations