Rx of choice in chronic alcoholic with normal RBS, normal BUN, but altered sensorium -

Ans. is 'a' i.e., Vitamin Bt injection IMo In chronic alcoholics wernicke's encephalopathy may be precipitated by administration of intravenous glucose solution.o This occurs because chronic alcoholics are thiamine deficient.Thiamine deficiency in alcohol abusers results from a combination of inadequate dietary intake, reduced gastrointestinal absorption, decreased hepatic storage and impaired utilization.o Thiamine is a cofactor for several key enzymes important in energy metabolism including transketolase. alphaketoglutarate dehydrogenase and pyruvate dehydrogenase\Thiamine requirement depends upon metabolic rate with the greatest need, during periods of high metabolic demand and high glucose intake.This is manifested by precipitation of wernicke's encephalopathy (WE) in susceptible patients by administration of intravenous glucose before thiamine supplementation.Wernickes encephalopathy may be iatrogenic ally precipitated by glucose loading in patients with unsuscepected thiamine deficiency.To avoid this complication, it has become standard practice in emergency departments to administer thiamine prior to or alone with slucose infusion, particularly in those who are at risk for thiamine deficiency.Patients at risk for Wernicke's encephalopathy should also receive thiamine supplementation. As an example, patients admitted for alcohol withdrawal typically receive thiamine 100 mg daily.Because gastrointestinal absorption of thiamine is erratic in alcoholic and malnourished patients oral administration of thiamine is an unreliable treatment of wernicke s encephalopathy.