A fictional 61-year-old admitted after a fall becomes tremulous and agitated, then develops confusion, gait ataxia and abnormal eye movements.
Listen for the assumption.
I attributed every feature to withdrawal and prescribed oral vitamins for tomorrow.
The neurological features raise suspected Wernicke’s encephalopathy, which requires prompt parenteral thiamine while withdrawal and alternative causes are managed.
I will assess glucose, injury, infection, liver disease and medication effects in parallel.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Confusion with gait and ocular abnormalities
- Poor nutritional intake
- Autonomic withdrawal features are present
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Use a monitored withdrawal regimen appropriate to the setting and do not let a score replace clinical assessment.
Correct. Treat suspected Wernicke’s promptly, assess capacity and safeguarding, and plan ongoing alcohol support after stabilisation.
I will document thiamine timing, withdrawal treatment, neurological trajectory and competing diagnoses.
What must remain explicit.
- Use current local alcohol-withdrawal and parenteral-thiamine policies.
- Monitor sedation, respiration, fluid and electrolyte status.
- Do not use phenytoin routinely for alcohol-withdrawal seizures.
Where reasoning fails.
- Diagnostic overshadowing
- Oral prophylaxis for suspected Wernicke’s
- Score-driven treatment without clinical review
Alcohol withdrawal risk with last use [time], withdrawal features/treatment [trend], Wernicke features and thiamine [time/route], competing causes [assessment] and monitoring/support plan [status].
Does your local pathway clearly distinguish thiamine prophylaxis from treatment of suspected Wernicke’s?