A 49-year-old with alcohol use disorder is confused and ataxic with horizontal nystagmus. Glucose is 3.9 mmol/L, magnesium is low, and there are no

Question

A 49-year-old with alcohol use disorder is confused and ataxic with horizontal nystagmus. Glucose is 3.9 mmol/L, magnesium is low, and there are no focal deficits. What is the most appropriate next step?

Accepted Answer

Give intravenous thiamine before glucose-containing fluids when feasible, plus magnesium repletion

Answer

Arrange outpatient neurology referral

Answer

Give glucose-containing fluids without vitamin replacement

Answer

Load phenytoin as first-line therapy

Answer

Give haloperidol and discharge once calm

Wernicke encephalopathy — RCPSC EM MCQ

A 49-year-old with alcohol use disorder is confused and ataxic with horizontal nystagmus. Glucose is 3.9 mmol/L, magnesium is low, and there are no focal deficits. What is the most appropriate next step?