Glucose Before Thiamine In Hypoglycemia

“Thiamine before glucose” is a bedside teaching that started with a sound physiologic concept and slowly hardened into dogma when dealing with patients with alcohol use disorder. Thiamine deficiency underlies Wernicke encephalopathy, a preventable but often missed neurologic emergency most commonly seen in alcohol use disorder, malnutrition, prolonged vomiting, and after bariatric surgery. The…