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Wernicke encephalopathy — ACEM Fellowship MCQ

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EasyNeurological emergenciesWernicke encephalopathyACEM Fellowship

A 48-year-old man with alcohol dependence presents to an Adelaide ED, triage category 3, with confusion, ataxia and horizontal nystagmus. Glucose is 3.4 mmol/L and he has been vomiting for 3 days. What is the most appropriate management?

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Correct answer: D — IV thiamine then glucose replacement

Confusion, ataxia and nystagmus in alcohol dependence is Wernicke encephalopathy; thiamine should precede glucose where possible.

Reference: Australian alcohol withdrawal guidelines; ACEM neurology curriculum