A 55-year old man who was a chronic alcoholic presented with confusion, ataxia, and diplopia. What is the treatment protocol?
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
Thiamine infusion alone
thiamine injection followed by glucose infusion
Glucose infusion alone
Glucose infusion followed thiamine injection
vitamins