A 55-year old man who was a chronic alcoholic presented with confusion, ataxia, and diplopia. What is the treatment protocol?
Thiamine infusion alone
thiamine injection followed by glucose infusion
Glucose infusion alone
Glucose infusion followed thiamine injection
The above features suggests Wernicke's encephalopathy which is due to Thiamine deficiency Thiamine deficiency leads to: 1. Beriberi: It can present with sensorimotor peripheral neuropathy, muscle weakness (dry beriberi) or tachycardia, cardiomegaly, high-output cardiac failure (wet beriberi). 2. Wernicke's encephalopathy: more commonly seen in alcoholics with chronic thiamine deficiency. It is characterized by : Global confusion Truncal ataxia Ophthalmoplegia Horizontal nystagmus 3. Korsakoff psychosis: Wernicke's encephalopathy symptoms and Memory loss and Confabulation The treatment for patients with symptoms of Wernicke's encephalopathy is to give thiamine 100 mg intravenously before administering glucose-containing IV fluids. Reference: Harpers illustrated biochemistry 30th edition
vitamins