A 45-year-old male with alcohol use disorder presents with confusion, ataxia, and horizontal nystagmus. What medication must be administered parenterally BEFORE any intravenous dextrose infusion to prevent permanent neurological damage?

Answer and explanation

Correct answer: A. Intravenous Thiamine (Vitamin B1) before dextrose

  1. Step 1: The classic triad of encephalopathy (confusion), oculomotor dysfunction (nystagmus/ophthalmoplegia), and gait ataxia defines Wernicke's encephalopathy.
  2. Step 2: Thiamine is a required cofactor for pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase in cerebral glucose metabolism.
  3. Step 3: Administering IV dextrose without thiamine depletes residual thiamine stores and precipitates acute, irreversible Korsakoff psychosis or death.
  4. Step 4: Identify IV thiamine.
Answer
Intravenous Thiamine (Vitamin B1).
Why not the others: 'Intravenous Pyridoxine' is used for isoniazid toxicity; 'Intravenous Folate' treats macrocytic anemia; 'Oral Cyanocobalamin' treats B12 deficiency neuropathy.

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