18th July 2023

A 27-year-old woman is brought to A&E by her partner who reports that she has been falling frequently at home

A 27-year-old woman is brought to A&E by her partner who reports that she has been falling frequently at home and has become increasingly confused. She had a roux-en-Y gastric bypass 2 months ago for obesity and type 2 diabetes mellitus. Since the bypass she has lost 5kg in weight and has been well. However, in the last 2 weeks she has been vomiting at home after having a ‘dodgy takeaway’. On examination, her abdomen is soft and non-tender and laparoscopic surgical sites are well healed and clean. When you ask her to walk, you note she has a wide based gait and restriction of lateral gaze in both eyes. A full neurological examination reveals normal power, tone, and reflexes in her upper and lower limbs. Her observations are as follows:

Temperature 37.4oC

Heart Rate 105

Blood Pressure 110/65

Respiratory Rate 18

Oxygen saturation 97% RA

Which of the following will most likely lead to the resolution of her symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.