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Wernicke's encephalopathy in alcohol dependence — SCE Acute Medicine MCQ

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ModerateNeurology and ophthalmologyWernicke's encephalopathy in alcohol dependenceSCE Acute Medicine

A 47-year-old man with alcohol dependence is admitted with vomiting and poor intake. On day 2 he becomes confused and ataxic with horizontal nystagmus. Glucose is 3.9 mmol/L, magnesium is 0.45 mmol/L and CT head is normal. What is the most appropriate next step in management?

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Correct answer: A — Give high-dose parenteral thiamine before carbohydrate and correct magnesium

Wernicke's encephalopathy is a clinical emergency, and parenteral thiamine should be given before carbohydrate because glucose can precipitate or worsen deficiency-related injury. Magnesium deficiency can impair thiamine utilisation and should be corrected. Normal CT does not exclude Wernicke's encephalopathy.

Reference: NICE CG100 alcohol-use disorders; BNF thiamine