A 60-year-old male with chronic alcoholism presents with confusion, ataxia, and horizontal nystagmus. What is the immediate treatment required to prevent irreversible neurological damage?

Answer and explanation

Correct answer: D. Intravenous thiamine (vitamin B1) before any glucose

  1. Step 1: The triad of confusion, ataxia, and ophthalmoplegia/nystagmus defines acute Wernicke encephalopathy caused by thiamine (vitamin B1) deficiency.
  2. Step 2: High-dose parenteral thiamine must be administered immediately prior to any glucose infusion, as glucose metabolism consumes residual thiamine stores and can precipitate acute Korsakoff psychosis or fatal brainstem necrosis.
Answer
Intravenous thiamine (vitamin B1) before any glucose.
Why not the others: 'Intravenous 50% dextrose bolus immediately' worsens neuronal injury by rapidly depleting remaining thiamine reserves; 'Intravenous haloperidol' does not treat the underlying nutritional deficiency; 'Oral cyanocobalamin' treats subacute combined degeneration, not Wernicke encephalopathy.

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