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Wernicke encephalopathy — RCPSC EM MCQ

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HardNeurological emergenciesWernicke encephalopathyRCPSC EM

A 46-year-old man with alcohol use disorder presents with confusion, ataxia and horizontal nystagmus. He has been vomiting for several days. Glucose is 3.4 mmol/L and magnesium is low. What is the most appropriate next step?

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Correct answer: E — Give IV thiamine before glucose-containing fluids and correct electrolytes

Wernicke encephalopathy is suggested by confusion, ataxia and nystagmus in a malnourished patient. Thiamine should be given before glucose to reduce risk of worsening neurological injury.

Reference: Canadian emergency medicine textbooks; alcohol-related neurological emergency practice