A patient presents to the emergency department with a blood alcohol concentration (BAC) of 0.18%. After reviewing the medication orders, which drug should the nurse administer first?
a. Thiamine (vitamin B1) 100 mg daily
b. Lorazepam (Ativan) 1 mg as needed
c. Folic acid (Vitamin B9) 0.4 mg daily
d. Dextrose 5% in 0.45 saline at 125 mL/hr
ANS: A
Thiamine is given to all patients with alcohol intoxication to prevent Wernicke's encephalopathy. Because Wernicke's encephalopathy can be precipitated by the administration of glucose solutions, the thiamine should be given before (or concurrently with) the 5% dextrose solution. Lorazepam would not be appropriate while the patient still has an elevated BAC. Folic acid may also be administered, but is not as important as thiamine.
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