A 52-year-old man with alcohol dependence is admitted confused, ataxic and with abnormal eye movements. His glucose is 3.0 mmol/L. What should be given first?

Answer and explanation

Correct answer: C. IV high-potency thiamine before or with the glucose

  1. Step 1: Confusion, ataxia and ophthalmoplegia in an alcohol-dependent patient indicate Wernicke encephalopathy.
  2. Step 2: Glucose given alone can use up thiamine stores and precipitate or worsen Wernicke encephalopathy, so thiamine comes first or together.
Answer
IV high-potency thiamine before or with the glucose.
Why not the others: Oral chlordiazepoxide alone with no vitamin replacement until the confusion improves: Benzodiazepine does not replace thiamine and delay risks permanent Korsakoff syndrome. IV 10 percent glucose first, with thiamine to be started the next morning: Glucose without thiamine can worsen the encephalopathy. IV haloperidol to control agitation, followed by a CT head after 24 hours: Haloperidol does not treat the cause and lowers seizure threshold.

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