مريض مدمن على الكحول جاء مشوشاً، يمشي بعدم اتزان، وعينه تتحرك بشكل غير طبيعي، وسكره منخفض. ما الترتيب الصحيح للعلاج؟

A client with alcohol dependence is confused, ataxic, with abnormal eye movements and low glucose. What is the correct treatment order?

1. IV thiamine before or with the glucose
2. No thiamine, because glucose is the cause
3. Oral thiamine after discharge
4. Glucose alone, then thiamine two days later

Answer: A) IV thiamine before or with the glucose. This suggests Wernicke encephalopathy from thiamine deficiency. Giving glucose without thiamine can worsen it, so IV thiamine is given before or with glucose and continued.