<prompt> A 55-year old man who was a chronic alcoholic presented with confusion, ataxia, and diplopia. What is the treatment protocol?Thiamine infusion alonethiamine injection followed by glucose infusionGlucose infusion aloneGlucose infusion followed thiamine injection  <response>: The above features suggests Wernickes encephalopathy which is due to Thiamine deficiency Thiamine deficiency leads to: 1. Beriberi: It can present with sensorimotor peripheral neuropathy, muscle weakness dry beriberi or tachycardia, cardiomegaly, high-output cardiac failure wet beriberi. 2. Wernickes encephalopathy: more commonly seen in alcoholics with chronic thiamine deficiency. It is characterized by : Global confusion Truncal ataxia Ophthalmoplegia Horizontal nystagmus 3. Korsakoff psychosis: Wernickes encephalopathy symptoms and Memory loss and Confabulation The treatment for patients with symptoms of Wernickes encephalopathy is to give thiamine 100 mg intravenously before administering glucose-containing IV fluids. Reference: Harpers illustrated biochemistry 30th edition 