Thiamine should be administered before glucose in alcoholics to prevent Wernicke encephalopathy.

• A. Before
• B. After
• C. Simultaneously
• D. Not necessary

Answer: (A)

In alcoholics, thiamine deficiency is common and brain neurons rely on thiamine to process glucose. Giving glucose before thiamine can rapidly drive carbohydrate metabolism with insufficient thiamine, precipitating or worsening Wernicke encephalopathy. Providing thiamine first ensures there’s enough cofactor for enzymes like pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase to handle the incoming glucose, helping prevent this neurologic emergency. That’s why the best approach is to administer thiamine before glucose. If glucose must be given urgently, thiamine should still be given first whenever possible; delaying thiamine is risky. Not necessary is incorrect because the risk is real in malnourished alcoholics.