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Wernicke's Encephalopathy — MRCPsych Paper B MCQ

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ModerateSubstance MisuseWernicke's EncephalopathyMRCPsych Paper B

A 45-year-old woman with a 10-year history of alcohol dependence is brought to the emergency department. She is undernourished and disorientated, with horizontal nystagmus, bilateral lateral rectus weakness and a broad-based unsteady gait. Her blood glucose is normal. What is the most appropriate treatment?

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Correct answer: B — Parenteral thiamine for at least 5 days, followed by oral thiamine

The correct answer is B. Confusion, ocular motor abnormalities and gait ataxia in an undernourished person with alcohol dependence indicate Wernicke's encephalopathy, a medical emergency caused by thiamine deficiency. NICE recommends immediate parenteral thiamine for at least 5 days unless Wernicke's encephalopathy is excluded, followed by oral thiamine. Oral thiamine alone is inadequate for established disease and is more appropriate for selected prophylactic situations. Hydroxocobalamin treats vitamin B12 deficiency, while folic acid treats folate deficiency; neither addresses the acute neurological syndrome. Intravenous glucose provides no thiamine and does not treat the underlying deficiency. Treatment should not be delayed while awaiting investigations.

Reference: National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications (CG100), section 1.2, recommendation 1.2.1.4. Published 2010; last updated 2017. https://www.nice.org.uk/guidance/CG100/chapter/recommendations