What is the rationale for giving thiamine before glucose in suspected alcohol-related emergencies?

• A. To increase glucose metabolism.
• B. To prevent Wernicke encephalopathy and refeeding complications.
• C. To treat methanol poisoning.
• D. To reduce lactic acidosis.

Answer: (B)

In suspected alcohol-related emergencies, thiamine deficiency is common because chronic alcohol use impairs nutrition and stores of vitamin B1. Glucose administration increases the brain’s need for thiamine to metabolize carbohydrates. If thiamine is not available first, a glucose load can precipitate or worsen brain energy failure, leading to Wernicke encephalopathy, a dangerous acute neurologic condition. Providing thiamine before glucose ensures the necessary cofactor is present for glucose metabolism, protecting against this neurologic injury and reducing the risk of refeeding-related metabolic complications that can follow a rapid carbohydrate load.