Final answer:
Thiamine deficiency should be checked in an alcoholic patient presenting with incoherence and impaired motor functions at the ER. Chronic alcohol consumption can lead to poor dietary intake and increased thiamine excretion, contributing to this deficiency and associated conditions like Beri-Beri and Wernicke's encephalopathy.
Step-by-step explanation:
Identification of Deficiency in an Alcoholic Patient
If a person known to be an alcoholic appears at the ER, stumbling around and mostly incoherent, the deficiency that should be checked is d) Thiamine. Thiamine deficiency is particularly common in alcoholics due to their poor dietary intake and the diuretic effect of alcohol, which increases the excretion of thiamine. The clinical condition of thiamine deficiency is known as ‘Beri-Beri’ and can manifest in various forms such as polyneuritis, edema, cardiovascular changes, and muscular atrophy. Specifically, alcoholics may develop Wernicke's encephalopathy, which is an acute manifestation of thiamine deficiency. Symptoms of thiamine deficiency include loss of appetite, weaknesses, and gastrointestinal disorders, all of which severely impact the body's ability to properly utilize carbohydrates, causing an accumulation of pyruvate and lactate.