In alcoholic ketoacidosis, which agent should be given first during treatment?

• A. Thiamine
• B. Glucose
• C. Folate
• D. Vitamin C

Answer: (A)

In alcoholic ketoacidosis, thiamine deficiency is common due to poor nutrition and chronic alcohol use, so it should be given before providing glucose. Thiamine is a crucial cofactor for enzymes that convert carbohydrates into energy; without it, administering glucose increases the demand for thiamine and can precipitate or worsen Wernicke’s encephalopathy and lactic acidosis. Administer thiamine first (for example, IV thiamine 100 mg) to replenish stores, then start glucose-containing fluids to address energy needs and help correct the metabolic derangements. Folate and vitamin C may be helpful later, but they are not immediate priorities, and glucose should not be given before thiamine to avoid iatrogenic neurological injury.