A 64-Year-Old Man Is Hospitalized with Abdominal Pain, Nausea, and Vomiting

A 64-year-old man is hospitalized with abdominal pain, nausea, and vomiting.  The patient has had several similar episodes in the past and was advised to avoid alcohol consumption.  Evaluation reveals epigastric tenderness and elevated serum amylase and lipase levels.  The patient is admitted, and treatment with bowel rest and intravenous fluids is begun.  During hospitalization, he develops new-onset confusion.  Physical examination shows horizontal nystagmus and gait ataxia.  Brain imaging reveals abnormalities in the mammillary bodies and periaqueductal gray matter.  Which of the following most likely precipitated this patient's current neurologic condition?

A) Abrupt alcohol cessation
B) Excessive hydration
C) Glucose infusion
D) Hypotonic fluid administration
E) Lack of anticoagulant use
F) Vitamin supplementation

Correct Answer:

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