ROSH Gastrointestinal Practice Exam

The primary treatment for a 55-year-old man with a history of alcoholism who is presenting with unsteady gait and confusion focuses on the prevention and treatment of Wernicke's encephalopathy, a condition caused by thiamine (vitamin B1) deficiency. This deficiency commonly occurs in individuals with alcohol use disorder due to poor nutritional intake, malabsorption, and impaired utilization of thiamine.

Administering thiamine is crucial because it helps in the proper metabolism of carbohydrates and is vital for energy production in the brain. In cases where thiamine deficiency is present, the brain relies on glucose for energy, and insufficient thiamine can lead to neurological symptoms such as confusion, gait abnormalities, and even severe consequences if not addressed promptly.

Folic acid, magnesium, and dextrose may be part of the overall management of an alcohol use disorder or nutritional deficiency, but they do not directly address the critical deficiency in thiamine that leads to the neurological symptoms displayed by the patient. Dextrose, in particular, should be administered with caution without accompanying thiamine, as it can worsen symptoms of Wernicke's encephalopathy if thiamine is deficient. Thus, the immediate focus should be on th