Why would women with hyperemesis gravidarum be at risk for Wernicke's encephalopathy, and what is the recommended treatment when starting dextrose-containing fluids?

• A. Due to poor intake and low thiamin; thiamin supplementation should be started with dextrose fluids
• B. Due to iron deficiency; iron supplementation should be started with dextrose fluids
• C. Dehydration; treat with saline only
• D. High glucose; treat with insulin therapy

Answer: (A)

In this scenario the key issue is thiamine deficiency in a malnourished patient with hyperemesis gravidarum and why glucose-containing fluids can precipitate Wernicke’s encephalopathy. Severe vomiting and poor intake deplete thiamine stores, and thiamine is a crucial cofactor needed to metabolize glucose. When dextrose is given to someone who is thiamine deficient, their body’s demand for thiamine skyrockets, which can trigger or worsen Wernicke’s encephalopathy. Therefore the best approach is to administer thiamine before or with starting dextrose-containing fluids to prevent this complication.

That’s why the correct answer is to recognize the risk from poor intake and low thiamin and to begin thiamin supplementation alongside dextrose fluids. The other options don’t address the thiamine deficiency risk or the prevention of Wernicke’s in this context.