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Wernicke encephalopathy — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsWernicke encephalopathySCE Acute Medicine

A 58-year-old man with alcohol dependence is admitted with confusion, ataxia and horizontal nystagmus. Glucose is 3.6 mmol/L and he has eaten little for a week. What is the most appropriate next step in management?

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Correct answer: D — Give high-dose parenteral thiamine before glucose-containing fluids where possible

The triad suggests Wernicke encephalopathy and parenteral thiamine should be given urgently, ideally before glucose if this does not delay emergency hypoglycaemia treatment. Oral vitamins are inadequate for suspected Wernicke's. MRI may support the diagnosis but should not delay treatment. The pearl is that Wernicke's is a clinical emergency and undertreatment risks Korsakoff syndrome.

Reference: NICE CG100; BNF thiamine