Rx of choice in chronic alcoholic with normal RES, normal BUN, but altered sensorium –
**Core Concept**
Thiamine (Vitamin B1) deficiency is a common complication in chronic alcoholics, leading to Wernicke-Korsakoff syndrome, characterized by altered sensorium, ataxia, and ophthalmoplegia. Thiamine plays a crucial role in the metabolism of glucose and other carbohydrates.
**Why the Correct Answer is Right**
The administration of thiamine is essential in this scenario to prevent the progression of Wernicke's encephalopathy, which can lead to severe brain damage and death. Thiamine supplementation helps to restore normal glucose metabolism, thereby alleviating the symptoms of altered sensorium. The normal renal function (normal BUN) and normal liver enzymes (normal RES) do not preclude the possibility of thiamine deficiency in chronic alcoholics.
**Why Each Wrong Option is Incorrect**
**Option A:** Folinic acid is used in the treatment of megaloblastic anemia, not in the management of altered sensorium in chronic alcoholics.
**Option B:** Niacin is essential for the metabolism of fatty acids and cholesterol, but it is not the primary treatment for altered sensorium in chronic alcoholics.
**Option C:** Pyridoxine (Vitamin B6) is crucial for brain function and the metabolism of amino acids, but it is not the specific treatment for Wernicke-Korsakoff syndrome.
**Clinical Pearl / High-Yield Fact**
Always remember to suspect and treat thiamine deficiency in chronic alcoholics with altered sensorium, as delayed treatment can lead to severe and irreversible brain damage.
**Correct Answer:** A. Thiamine