Thiamine for Wernicke's — MRCPsych Paper B MCQ

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EasySubstance MisuseThiamine for Wernicke'sMRCPsych Paper B

A 40-year-old man with alcohol dependence presents to the emergency department with acute confusion and ophthalmoplegia. Wernicke's encephalopathy is suspected. Which vitamin should be administered parenterally as immediate treatment?

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Correct answer: A — Thiamine (vitamin B1)

The correct answer is A, thiamine (vitamin B1). Alcohol dependence combined with acute confusion and ophthalmoplegia strongly suggests Wernicke's encephalopathy, an emergency caused by thiamine deficiency. NICE recommends immediate parenteral thiamine for suspected Wernicke's encephalopathy, continued for at least 5 days unless the diagnosis is excluded, with oral thiamine subsequently. Ascorbic acid, colecalciferol, cobalamin and folic acid deficiencies can occur with poor nutrition but do not treat this acute syndrome. Vitamin B12 deficiency usually causes megaloblastic anaemia and more gradual neurological dysfunction, while folate replacement does not reverse Wernicke's encephalopathy.

Reference: NICE. Alcohol-use disorders: diagnosis and management of physical complications (CG100), section 1.2.1.4: Wernicke's encephalopathy. 2010. https://www.nice.org.uk/guidance/CG100/chapter/recommendations