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Old 04-21-2012
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Question Management of this disoriented homeless woman?

A middle-aged woman is found wandering the streets with an abnormal gait. Police officers bring her to the hospital. She mumbles when asked for her name and age. She is not oriented to time or place. Her blood pressure is 120/ 80 mmHg and her heart rate is 80/min. She is afebrile. Mucous membranes are moist and the pupils are normal and reactive to light. She moves all of her extremities, and her deep tendon reflexes are symmetric. Which of the following is the best initial treatment for this patient?
A. Naloxone
B. Flumazenil
C. Thiamine
D. Haloperidol
E. Clonidine

answer unknown
source is not NBME
please give explanation
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Old 04-21-2012
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THIAMINE WK syndrome
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Old 04-21-2012
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Thiamine ..i think in any homeless, unconscious, disoriented, alcoholic patient we start with thiamine, naloxone and dextrose.

thiamine comes first as it can reverse WK syndrome if given with in time...
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Old 04-21-2012
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yup. u guys seem correct.
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Old 04-22-2012
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Yup is thiamine, in the history they said pupils where normal so there is no reason to suspect opiate overdose (or any reason to pick naloxone)
The most common cause of abnormal gait in homeless people along with that history is chronic alcohol consumption, one must always give thiamine BEFORE GLUCOSE is given, because if done otherwise you are gonna screw the encephalopathy even more
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