一位有慢性酒精中毒史的病人因戒斷症狀入院。醫師開立了維生素 B1（Thiamine）。給予此藥物的主要理據為何？
A client with a history of chronic alcoholism is admitted with signs of alcohol withdrawal. The healthcare provider prescribes thiamine (Vitamin B1). What is the primary rationale for this medication?
- ATo stabilize the blood glucose levels.穩定血糖水平。
- BTo prevent the development of Wernicke-Korsakoff syndrome.✓ 正解預防威尼克-柯薩可夫症候群的發生。
- CTo decrease the severity of alcohol cravings.減輕酒精渴求的嚴重程度。
- DTo treat alcohol-induced liver cirrhosis.治療酒精引起的肝硬化。
慢性酒精中毒病人常因飲食不均衡及酒精干擾吸收，導致嚴重的維生素 B1（Thiamine）缺乏。這題的核心知識點是預防神經系統的永久性損傷。缺乏 Thiamine 會引發 Wernicke 腦病（症狀包括意識混亂、眼肌麻痺、步態不穩）以及隨後不可逆的 Korsakoff 症候群（記憶喪失、虛構症）。給予 Thiamine（B）是為了保護神經細胞代謝，預防這些併發症。酒精戒斷通常使用 Benzodiazepines 來緩解症狀或焦慮（C），Thiamine 並無此作用。酒精會導致低血糖，但 Thiamine 不是用來升糖的（A），也不是治療肝硬化的藥物（D）。臨床護理上，在給予這類病人含糖點滴前，通常會先給 Thiamine，以防葡萄糖代謝耗盡殘餘的 B1 誘發急性腦病。
Patients with chronic alcoholism often develop severe vitamin B1 (thiamine) deficiency due to poor diet and alcohol-related impairment of absorption. The core knowledge point of this question is the prevention of permanent neurological damage. Thiamine deficiency can trigger Wernicke's encephalopathy (with symptoms including confusion, ophthalmoplegia, and ataxia) and subsequently irreversible Korsakoff's syndrome (memory loss, confabulation). Administering thiamine (B) protects neural cell metabolism and prevents these complications. Alcohol withdrawal is generally managed with benzodiazepines to relieve symptoms or anxiety (C), and thiamine does not have this effect. Alcohol may cause hypoglycemia, but thiamine is not used to raise blood sugar (A), nor is it a treatment for cirrhosis (D). Clinically, before giving these patients glucose-containing IV fluids, thiamine is generally given first to prevent glucose metabolism from exhausting residual B1 and triggering acute encephalopathy.
美國 NCLEX 重視 Wernicke-Korsakoff 的機轉與預防；台灣臨床對於酒精戒斷病人也會給予「Banana Bag」（含多種維生素的黃色點滴），但對先給 B1 再給 Glucose 的順序邏輯教育需更普及。