In Wernicke-Korsakoff syndrome, thiamine should be administered before glucose.

• A. Thiamine before glucose
• B. Glucose before thiamine
• C. Vitamin C before any glucose
• D. No vitamin treatment is indicated

Answer: (A)

In suspected Wernicke-Korsakoff syndrome, giving thiamine before any glucose is essential. Thiamine is a vital cofactor for enzymes that convert glucose into energy. If glucose is given first in a thiamine-deficient patient, the brain’s already stressed metabolism demands more thiamine, which can precipitate or worsen Wernicke’s encephalopathy and brain injury. By administering thiamine first, you replenish the deficit and allow subsequent carbohydrate metabolism to proceed safely. Therefore the best choice is thiamine before glucose. The other options don’t address the underlying deficiency or the precipitating risk, and withholding vitamin treatment is inappropriate.