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Wernicke's encephalopathy — MCCQE Part 1 MCQ

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HardAltered Level of ConsciousnessWernicke's encephalopathyMCCQE Part 1

A malnourished man with alcohol use disorder has confusion, ataxia and nystagmus. Glucose is normal. Which immediate treatment best follows Canadian guidance?

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Correct answer: D — Parenteral thiamine 200–300 mg and continued treatment

The triad strongly suggests Wernicke encephalopathy, which is a clinical emergency. Canadian guidance recommends 200 to 300 mg of thiamine intravenously or intramuscularly, with parenteral treatment for at least five days unless the diagnosis is excluded, followed by oral thiamine. Oral vitamins are unreliable in acute deficiency. Thiamine should be given promptly, but lifesaving glucose must never be withheld from a hypoglycemic patient merely to administer thiamine first; this patient is not hypoglycemic.

Reference: Canadian Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder, https://helpwithdrinking.ca/wp-content/uploads/2023/10/FINAL-Canadian-AUD-guidelines_ENG.pdf