**Core Concept**
Classical galactosemia is a genetic disorder caused by deficiency of galactose-1-phosphate uridyltransferase (GALT), leading to toxic accumulation of galactose-1-phosphate. This results in multi-organ damage, especially in the liver, kidneys, and brain, with early onset symptoms including jaundice, hepatomegaly, and cataracts. Dietary galactose elimination is critical to prevent further damage.

**Why the Correct Answer is Right**
In classical galactosemia, galactose is converted to galactitol via the Leloir pathway, and galactitol accumulates and causes osmotic toxicity, particularly in the lens, leading to cataracts. Once cataracts develop, they are irreversible and cannot be reversed by dietary management. The key point is that cataracts are a **consequence of ongoing galactose exposure** and not a reversible condition after onset. Thus, eliminating galactose from the diet **prevents further cataract formation**, but **does not reverse existing cataracts**.

**Why Each Wrong Option is Incorrect**
Option A: E. coli neonatal sepsis is common – This is incorrect because classical galactosemia does **not** predispose to E. coli sepsis; however, this statement is **not** true in the context of galactosemia, and thus this option is a distractor. The real risk is **neonatal sepsis due to galactosemia-related metabolic crisis**, but it's not specifically linked to E. coli.
Option C: Galactose converts to galactitol which is toxic to brain – This is **true**; galactitol accumulation causes osmotic damage in neural tissue, contributing to neurological deterioration.
Option D: Children with Duarte variant of galactosemia are asymptomatic – This is **true**; Duarte variant is a milder form with minimal or no symptoms, unlike classical galactosemia.

**Clinical Pearl / High-Yield Fact**
In classical galactosemia, **early dietary galactose restriction prevents complications**, but **cataracts that develop are irreversible**—this is a key exam point distinguishing galactosemia from other metabolic disorders.

✓ Correct Answer: B. Elimination of galactose in diet will not reverse cataract