A 32-year-old woman with alcoholism and cocaine use dating back at least 10 years comes to the emergency room after 48 h of recurrent vomiting and hematemesis. She reports abdominal discomfort that preceded the vomiting by a few days. For at least 36 h, she has been unable to keep ethanol in her stomach. Intravenous fluid replacement is started while she is being transported to the emergency room, and while in the emergency room she describes progressive blurring of vision. Over the course of 1 h, she becomes increasingly disoriented, ataxic, and dysarthric. Which of the following is the most likely explanation for her rapid deterioration?

a. Dehydration

b. Hypomagnesemia

c. Wernicke’s encephalopathy

d. Hypoglycemia

e. Cocaine overdose

the answer is below…

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