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Wernicke's encephalopathy — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologyWernicke's encephalopathySCE Acute Medicine

A malnourished patient with alcohol dependence has confusion, ophthalmoplegia, ataxia and glucose 3.2 mmol/L. Dextrose is being prepared. What should happen next?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Give parenteral thiamine before or alongside glucose

The best answer is “Give parenteral thiamine before or alongside glucose”. This is correct because the clinical triad in a malnourished patient requires immediate high-dose parenteral treatment. Hypoglycaemia must also be corrected and should not be dangerously delayed, but thiamine is given first or concurrently where possible. Oral absorption is unreliable in this emergency and laboratory confirmation is unnecessary.

Reference: UK clinical guidelines for alcohol treatment: https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/16-alcohol-care-in-acute-hospitals