In patients with chronic alcohol use, which deficiency is most common, and what prophylaxis is recommended before glucose administration to prevent a specific complication?

In patients with chronic alcohol use, which deficiency is most common, and what prophylaxis is recommended before glucose administration to prevent a specific complication?

• A. Thiamine deficiency; parenteral thiamine prior to glucose administration
• B. Folic acid deficiency; intravenous folic acid before glucose
• C. Vitamin C deficiency; intravenous vitamin C before glucose
• D. Niacin deficiency; oral niacin before glucose

Answer: (A)

In chronic alcohol use, thiamine (vitamin B1) deficiency is the most common nutritional problem. When glucose is administered to someone who is thiamine-deficient, the body’s demand for thiamine as a cofactor in carbohydrate metabolism rises quickly. Without adequate thiamine, this rapid carbohydrate load can precipitate or worsen Wernicke’s encephalopathy, an acute and potentially reversible neuropsychiatric emergency if treated promptly. Therefore the best approach is to give thiamine parenterally before any glucose administration to prevent this complication. Providing high-dose IV or IM thiamine ensures rapid replenishment in a patient who may have poor oral absorption and depleted stores. While folate deficiency and other vitamins are also common in alcohol use, they do not address the immediate risk associated with glucose administration in a thiamine-deficient patient.

In chronic alcohol use, thiamine (vitamin B1) deficiency is the most common nutritional problem. When glucose is administered to someone who is thiamine-deficient, the body’s demand for thiamine as a cofactor in carbohydrate metabolism rises quickly. Without adequate thiamine, this rapid carbohydrate load can precipitate or worsen Wernicke’s encephalopathy, an acute and potentially reversible neuropsychiatric emergency if treated promptly.

Therefore the best approach is to give thiamine parenterally before any glucose administration to prevent this complication. Providing high-dose IV or IM thiamine ensures rapid replenishment in a patient who may have poor oral absorption and depleted stores. While folate deficiency and other vitamins are also common in alcohol use, they do not address the immediate risk associated with glucose administration in a thiamine-deficient patient.