Water-soluble vitamin deficiency and toxicity Quiz: Ace Your Exams
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A 32-year-old woman in the intensive care unit is brought to the attention of the on-call physician for acute mental status changes shortly after a nurse initiated dextrose supplementation. She was admitted to the hospital 1 week ago for severe acute pancreatitis. Past medical history includes anorexia nervosa and 2 hospital admissions in the past year for alcohol withdrawal. Temperature is 37.0°C (98.6°F), pulse is 92/min, respirations are 18/min, and blood pressure is 125/85 mmHg. BMI is 17.5 kg/m2. She is confused and disoriented to time, place and person. Pupils are equal and reactive, and horizontal nystagmus is elicited on lateral gaze. Fundoscopy is normal. Motor strength is 5/5 in the upper extremities and 2/4 in bilateral lower extremities. Deep tendon reflexes of the knee and ankle are 1+ bilaterally. Rapid glucose test is 70 mg/dL. Laboratory investigations are noncontributory. Which of the following enzymes is likely inhibited considering the most likely diagnosis in this patient?
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