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Malignant pleural effusion — ABIM Board MCQ

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HardPulmonary/Critical CareMalignant pleural effusionABIM Board

A 53-year-old with alcohol use disorder, poor nutrition, confusion, ataxia, and horizontal nystagmus is admitted for suspected Wernicke encephalopathy. His glucose is 68 mg/dL. Which immediate vitamin strategy is appropriate?

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Correct answer: C — Administer parenteral thiamine and correct hypoglycemia concurrently

Poor nutrition and suspected Wernicke encephalopathy favor prompt parenteral thiamine. ASAM states that glucose and thiamine may be given in any order, so hypoglycemia treatment should not be delayed while vitamin therapy is arranged.

Reference: ASAM Clinical Practice Guideline on Alcohol Withdrawal Management: https://www.asam.org/docs/default-source/quality-science/the_asam_clinical_practice_guideline_on_alcohol-1.pdf