What is a major risk if thiamine is not administered before glucose in alcohol withdrawal?

A major risk of not administering thiamine before glucose in the context of alcohol withdrawal is Korsakoff syndrome, a severe neurological disorder associated with thiamine deficiency. Thiamine, or vitamin B1, is crucial for glucose metabolism and the maintenance of normal brain function. In alcohol-dependent individuals, thiamine levels are often depleted due to inadequate nutritional intake and impaired absorption.

When glucose is administered without prior thiamine supplementation, there is a risk of precipitating or exacerbating Weirnicke's encephalopathy, which can evolve into Korsakoff syndrome if not treated promptly. This condition is characterized by severe memory disturbances, confabulation, and deficits in learning. The brain's inability to properly metabolize glucose without sufficient thiamine can lead to neuronal injury, exacerbating the cognitive deficits typical of these syndromes.

Understanding this mechanism is critical for managing patients in alcohol withdrawal to prevent long-term neurological complications and ensure proper recovery.