Wernicke – Thiamine Before Glucose — SCE Neurology MCQ

Correct answer: A — Parenteral thiamine before or alongside glucose correction

The best answer is “Parenteral thiamine before or alongside glucose correction”. Suspected Wernicke encephalopathy is a clinical emergency requiring high-potency parenteral thiamine, while symptomatic hypoglycaemia must also be corrected promptly; thiamine should precede or accompany carbohydrate rather than causing a dangerous glucose delay. “Delay glucose until MRI confirms Wernicke encephalopathy” is less appropriate because imaging is not sufficiently sensitive to justify postponing time-critical therapy “Give oral thiamine alone and review the patient tomorrow” is less appropriate because intestinal absorption is unreliable in a high-risk acutely ill patient “Correct glucose first and defer thiamine for several days” is less appropriate because a carbohydrate load without thiamine can exacerbate deficiency and delaying replacement loses neurological benefit “Treat with intravenous aciclovir without vitamin replacement” is less appropriate because the classic nutritional syndrome is not treated by antiviral therapy

Reference: NICE CG100: Alcohol-use disorders — physical complications. https://www.nice.org.uk/guidance/cg100/chapter/Recommendations