The Question
A 48-year-old woman is brought to the emergency department by her husband due to 3 days of worsening confusion, an unsteady gait, and seeing double. Her medical history is notable for obesity, for which she underwent a Roux-en-Y gastric bypass 5 years ago, with an initial weight loss of 90 lbs. For the past week, she has had a viral gastroenteritis with significant nausea, vomiting, and poor oral intake. On examination, she is afebrile with a heart rate of 105/min and blood pressure of 110/68 mm Hg. She is disoriented to time and place. Neurologic examination reveals bilateral horizontal nystagmus on lateral gaze, an inability to adduct the left eye on right lateral gaze, and a wide-based, ataxic gait. She is unable to stand with her feet together. Basic laboratory studies, including a complete blood count and comprehensive metabolic panel, are notable only for a serum potassium of 3.3 mEq/L. Which of the following is the most appropriate immediate intervention?
See the answer and explanation below:
Post-Call Recovery Reads
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View on AmazonThe Correct Answer
A
Explanation
Clinical Pearl:
In a patient with risk factors for thiamine deficiency (e.g., bariatric surgery, alcohol use disorder, malnutrition) who presents with acute encephalopathy, oculomotor dysfunction, and gait ataxia, Wernicke encephalopathy must be presumed and treated emergently with high-dose parenteral thiamine before any glucose-containing fluids are administered.
Explanation:
General Internal Medicine
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