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Wernicke encephalopathy — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsWernicke encephalopathySCE Acute Medicine

A malnourished 52-year-old man with alcohol dependence presents with confusion, ataxia and horizontal nystagmus. Glucose is 3.4 mmol/L and he has not eaten for two days. What is the most appropriate next step in management?

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Correct answer: C — Give parenteral thiamine before or alongside glucose-containing treatment

The triad of confusion, ataxia and ophthalmoplegia in a malnourished alcohol-dependent patient suggests Wernicke encephalopathy. Parenteral thiamine should be given urgently before or alongside glucose because carbohydrate can worsen thiamine demand. Oral vitamins are inadequate in suspected Wernicke encephalopathy. This is a clinical diagnosis and treatment should not wait for imaging.

Reference: NICE CG100, BNF