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Wernicke encephalopathy — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseWernicke encephalopathySCE Acute Medicine

A 58-year-old woman is assessed on the acute medical unit. She is alcohol dependent and presents with confusion, ataxia and nystagmus. She has been vomiting for several days. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: B — Give parenteral thiamine immediately

Give parenteral thiamine immediately is the best answer because the classic triad indicates Wernicke encephalopathy and requires urgent parenteral thiamine. Give intramuscular adrenaline 500 micrograms is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Do not wait for confirmatory testing because delay risks Korsakoff syndrome.

Reference: NICE CG100; BNF