A 52 year old woman was admitted  the previous night with an altered level of consciousness which improved rapidly with administration of glucose. She is referred to ICU the next day with confusion, ataxia and a worsening level of consciousness. Her CT head was normal.

The blood sugar level in the morning is 8 mmol/l on a 5% Dextrose infusion at 80 ml/hr. Her full blood count from the previous night is available.

Test

Value

Normal Range

Hb

88

130-180 g/l

WCC

7.4 x 109 /l

4.5 – 11 x 109/l

Platelets

88 x 109 /l

150 – 400 x 109/l

MCV

110 fl

80 – 98 fl

MCH

30 pg

27 – 33 pg

MCHC

320 g/l

310 – 360 g/l

PT

12 sec

(12-18)

APTT

36

32-38

1.  What is the likely cause of her confusional state?

2.  What specific treatment would you institute for resolution of her mental status?

[Click here to toggle visibility of the answers]

College Answer

1.  What is the likely cause of her confusional state?
Wernickes encephalopathy

2.  What specific treatment would you institute for resolution of her mental status?
Thiamine 100 mg IV

Discussion

This question closely resembles Question 13.3 from the second paper of 2013.