A homeless patient with chronic alcoholism presents to clinic for confusion and ataxia. Which immediate nutritional intervention is highest priority and why?

• A. Begin high-dose oral vitamin C to boost immune function and treat scurvy immediately, which is the most common cause of confusion in alcoholics.
• B. Administer thiamine (B1) promptly before giving glucose, because alcoholics are at high risk for thiamine deficiency and glucose without thiamine can precipitate Wernicke encephalopathy.
• C. Administer folic acid intramuscularly first, since folate replenishment will immediately reverse confusion and prevent ataxia in alcoholics.
• D. Start high-dose niacin to correct pellagra, because pellagra is rapidly fatal and more common than thiamine deficiency in chronic alcoholism.

Answer: (B)