What should be given to intoxicated patients before or with IV glucose?

• A. IV vitamin C
• B. Oral glucose
• C. IV thiamine after glucose
• D. IV thiamine before or with IV glucose

Answer: (D)

Intoxicated patients are at risk for thiamine deficiency, and glucose metabolism relies on thiamine as a key cofactor. Providing IV glucose without sufficient thiamine can precipitate or worsen Wernicke’s encephalopathy because the brain can’t efficiently metabolize the glucose without thiamine. Giving thiamine intravenously before or at the same time as IV glucose supplies the needed cofactor and protects brain tissue from energy failure. This is why the best approach is IV thiamine before or with IV glucose. Other options don’t address this risk—vitamin C isn’t relevant, oral glucose isn’t appropriate in this acute setting, and giving thiamine after glucose wouldn’t prevent the problem.