Wernicke's Encephalopathy — RACP Adult Medicine MCQ
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Correct answer: D — IV thiamine 500 mg TDS for 3 days
Wernicke's encephalopathy (confusion, ophthalmoplegia, ataxia) requires urgent parenteral thiamine. The recommended dose in Australia is IV thiamine 500 mg TDS (in 100 mL normal saline over 30 minutes) for at least 3 days. Oral thiamine is inadequately absorbed in malnourished alcoholic patients. Thiamine must be given BEFORE any glucose-containing fluids to avoid precipitating Wernicke's encephalopathy.
Reference: eTG – 2025 – Neurology; RANZCP – 2024 – Alcohol Use Disorder Guidelines