Which treatment is recommended urgently if Wernicke encephalopathy is suspected?

• A. Administer high-dose thiamine before glucose
• B. Administer glucose before thiamine
• C. Administer vitamin C only
• D. No treatment is necessary

Answer: (A)

Wernicke encephalopathy is a medical emergency caused by thiamine deficiency, and the brain relies on thiamine to metabolize glucose. If glucose is given before thiamine, the brain’s energy failure can worsen because the increased glucose demand cannot be met without adequate thiamine, potentially accelerating brain injury. Therefore, the best course is to administer high-dose thiamine urgently before any glucose-containing fluids. This replenishes the essential cofactor for key enzymes in energy production and helps prevent progression to irreversible damage. Administering glucose first, giving vitamin C alone, or doing nothing do not address the deficient state and can lead to worse outcomes.