Question

A 36-year-old woman presents with confusion, a lack of control over her body, and unusual eye movements. She appears to be malnourished, and she shows signs of poor hygiene. She has been vomiting recently. Her pulse is 80/min, blood pressure is 122/70 mm Hg, temperature is 98.4° Fahrenheit (36.9 °C), and respiration is normal.

What is the next best step in the management of this patient?

1 Intravenous glucose
2 Intravenous thiamine
3 Intravenous vitamin B12
4 Diazepam
5 Toxicological screening

Answer 1

The 36-year-old woman's symptoms are indicative of Wernicke's encephalopathy due to thiamine deficiency, therefore, the next best step is to administer intravenous thiamine before glucose to prevent exacerbation of her condition.

Step-by-step explanation:

The presentation of a 36-year-old woman with confusion, poor coordination, unusual eye movements, signs of malnourishment, and vomiting suggests the possibility of a condition known as Wernicke's encephalopathy, which is associated with thiamine (vitamin B1) deficiency. Thiamine should always be administered before glucose in such cases to prevent precipitating or worsening Wernicke's encephalopathy. This is because the administration of glucose can further deplete thiamine reserves in the body, potentially exacerbating the condition. Thus, the next best step in the management of this patient is to administer intravenous thiamine.

Administration of thiamine before glucose is standard protocol in patients with suspected thiamine deficiency due to the critical role thiamine plays in glucose metabolism. If glucose is administered before thiamine, patients at risk could develop acute neurological symptoms as the glucose metabolism process requires thiamine. Hence, the correct and immediate treatment is crucial for preventing irreversible brain damage.