A 39-year-old woman with prior Roux-en-Y bypass has had 3 weeks of vomiting and now has confusion, horizontal nystagmus, and gait ataxia. Glucose is

Question

A 39-year-old woman with prior Roux-en-Y bypass has had 3 weeks of vomiting and now has confusion, horizontal nystagmus, and gait ataxia. Glucose is 58 mg/dL. What should be done first?

Accepted Answer

Give IV thiamine, then correct glucose and magnesium

Answer

Give intramuscular vitamin B12, then correct the low glucose

Answer

Give IV dextrose, then oral thiamine after neurologic recovery

Answer

Obtain urgent brain MRI, then start empiric vitamin replacement

Answer

Begin enteral feeding with daily oral multivitamin replacement

Bariatric surgery follow-up — USMLE Step 3 MCQ

A 39-year-old woman with prior Roux-en-Y bypass has had 3 weeks of vomiting and now has confusion, horizontal nystagmus, and gait ataxia. Glucose is 58 mg/dL. What should be done first?