Why should we give thiamine before glucose?

[Samarah]

It's mentioned that in alcoholics with Wernick's encephalopathy we should give IV thiamine before giving IV glucose. Why is that?

[armada81]

because if glucose is given first , it will use an important substrate of thiamine which facilitate the action of many enzymes of TCA cycle , that will result in further depleting of thiamine -----> worsen wernicke's encephalopathy and also prevent TCA cycle from using any further glucose ....

[Jones_WILLY]

First take a look at the Glycolysis pathway... After a cascade of changes Glucose--->Pyruvate which is key to your question... But to really understand why giving Thiamine first is so important you really should understand this next part..
There are three important reactions in the body that require the following Co-factors...
*Thiamine pyrophospate (TPP)
Lipoic Acid
Coenzyme A
FAD(H2) "Riboflavin"
NAD(H) "Niacin"
(Tender,Loving,Care,For,Nancy)

The Co-factors work together with the Enzymes to allow the following reactions to work...
1. Pyruvate----PDH-->Acetyl CoA
2. AlphaKetoglutarate---AlphaKetoglutarate Dehydrogenase-->Succinyl CoA
3. Leucine, Isoleucine, Valine---BranchChain Ketoacid Dehydrogenase-----> AcetylCoa, PropionylCoA

If you do not have the Cofactors the Enzymes in the reactions either don't work or work way to slow..
For your question you need to worry about all these reactions but i tend to focus on Reaction #1.. After glycolysis gives you Pyruvate there are two different pathways Pyruvate can go...

Lactate<-------LDH----Pyruvate----PDH+(Cofactor)------->AcetylCoA

When A DRUNKard comes into your office missing thiamine. The Pyruvate--->Acetyl Coa reaction wont work and the only pathway that is left is Pyruvate---->Lactate... So if you were to give the drunk just glucose they would drop dead because there is only one Pathway to take which is Pyruvate---->Lactate causing lactic acidosis and eventual death... When you give (Thiamine) first it allows the body to replenish the Cofactors so that the Pyruvate--->acetylCoA pathway can be used instead of making all that lactic ACID... Obviously there a few other reactions that do not work without the CoFactors but I thought this one is the easiest to see the direct consequences...

Sorry for the long winded explanation but i was having difficulty with this concept and this is how i was able to sort things out. Make sure to checkout the other reactions that need those Cofactors they are all important for the step... Hope this helps!

If anyone catches any big flaws please comment...

~PG

[doc_study]

Very nice indeed.......Thanks

[adominguez]

The effects of Thiamine to prevent Encephalopathy are understandable but not accurate. Let me explain;

In 1981, a group of doctors (I can't remember their names right now) published a study reporting Thiamine in the malnutrition patient suffering from hypoglycemia diagnosed with Wernick's Encephalopathy corrected the encephalopathy. The patient was already encephalitic. The study also reveals the study was concluded after research documented from four cases. FOUR! Therefore, it was also documented, Thiamine would be administered to prevent Wernick's Encephalopathy prior to administering Dextrose whether it's 50%, 25%, or 10%.

Today, there is still no evidence of Thiamine PREVENTING Wernick's Encephalopathy. Studies have shown no difference in outcome for patient's who received Thiamine compared to patient's who did not receive Thiamine.

The greatest downfall of any medical professional is the mindset of, "this is the way we've always done it". Let's eliminate this mindset and treat our patients for their conditions, not the conditions they may be subject to.

[Kittycat]

Hi could someone please explain the other two reactions that Willy didn't explain. Awesome on your answer btw Willy thanks for typing all that out.

[Erijah]

Originally Posted by Jones_WILLY

First take a look at the Glycolysis pathway... After a cascade of changes Glucose--->Pyruvate which is key to your question... But to really understand why giving Thiamine first is so important you really should understand this next part..
There are three important reactions in the body that require the following Co-factors...
*Thiamine pyrophospate (TPP)
Lipoic Acid
Coenzyme A
FAD(H2) "Riboflavin"
NAD(H) "Niacin"
(Tender,Loving,Care,For,Nancy)

The Co-factors work together with the Enzymes to allow the following reactions to work...
1. Pyruvate----PDH-->Acetyl CoA
2. AlphaKetoglutarate---AlphaKetoglutarate Dehydrogenase-->Succinyl CoA
3. Leucine, Isoleucine, Valine---BranchChain Ketoacid Dehydrogenase-----> AcetylCoa, PropionylCoA

If you do not have the Cofactors the Enzymes in the reactions either don't work or work way to slow..
For your question you need to worry about all these reactions but i tend to focus on Reaction #1.. After glycolysis gives you Pyruvate there are two different pathways Pyruvate can go...

Lactate<-------LDH----Pyruvate----PDH+(Cofactor)------->AcetylCoA

When A DRUNKard comes into your office missing thiamine. The Pyruvate--->Acetyl Coa reaction wont work and the only pathway that is left is Pyruvate---->Lactate... So if you were to give the drunk just glucose they would drop dead because there is only one Pathway to take which is Pyruvate---->Lactate causing lactic acidosis and eventual death... When you give (Thiamine) first it allows the body to replenish the Cofactors so that the Pyruvate--->acetylCoA pathway can be used instead of making all that lactic ACID... Obviously there a few other reactions that do not work without the CoFactors but I thought this one is the easiest to see the direct consequences...

Sorry for the long winded explanation but i was having difficulty with this concept and this is how i was able to sort things out. Make sure to checkout the other reactions that need those Cofactors they are all important for the step... Hope this helps!

If anyone catches any big flaws please comment...

~PG

Thanks so much