A 54-Year-Old Woman Is Brought to the Physician by Her

A 54-year-old woman is brought to the physician by her brother because of abdominal pain and vomiting. She had similar episodes which resolved without treatment. Laboratory tests show high serum amylase which she is admitted, and treatment with bowel rest and intravenous fluids is begun. In the next morning she is evaluated for a new confusion and agitation. She is unable to personally give a history. On mental status examination, she is confused and oriented only to person. She recalls 0 out of 3 words after 5 minutes. Neurologic examination shows horizontal nystagmus on lateral gaze. She has difficulty walking without assistance. 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