Alcoholic with confusion and ophthalmoplegia (366/1700)

A 65yo known alcoholic is brought into hospital with confusion, aggressiveness and
ophthalmoplegia. He is treated with diazepoxide. What other drug would you like to prescribe?
a. Antibiotics
b. Glucose
c. IV fluids
d. Disulfiram
e. Vit B complex

























answer: E

Wernicke-Korsakoff Syndrome
• alcohol-induced amnestic disorders due to thiamine deficiency
• necrotic lesions: mammillary bodies, thalamus, brainstem

• Wernicke’s encephalopathy (acute and reversible): triad of nystagmus (CN VI palsy), ataxia, and
confusion
 
• Korsakoff’s syndrome (chronic and only 20% reversible with treatment): anterograde amnesia
and confabulations; cannot occur during an acute delirium or dementia and must persist beyond usual duration of intoxication/withdrawal

• management
Wernicke’s: thiamine 100 mg PO OD x 1-2 wk
Korsakoff’s: thiamine 100 mg PO bid/tid x 3-12 mo