Thiamine before glucose in acute alcohol ingestion - True?

Q: 44 year old male with known history of alcohol abuse - a frequent flyer to ED - presented again with acute alcohol ingestion. Blood glucose noted to be 40 mg/dL. Admitting resident decided to hold infusion of dextrose before administering thiamine to avoid the risk of Wernicke's encephalopathy. Being an attending, do you agree with the decision? (select one)

A) Yes
B) No


Answer: No

There is no real evidence based literature to support the classic practice of holding dextrose infusion before thiamine in alcoholic patients to avoid Wernicke's encephalopathy. Risks and benefits should be weighed including the complications of  hypoglycemia. 

#neurology



References:

1. Schabelman E, Kuo D. Glucose before thiamine for Wernicke encephalopathy: a literature review. J Emerg Med 2012; 42:488. 

2. Hack JB, Hoffman RS. Thiamine before glucose to prevent Wernicke encephalopathy: examining the conventional wisdom. JAMA 1998; 279:583.