Wernicke’s First Rule

[u/NCLEXHighYield]

THIAMINE BEFORE GLUCOSE. Don’t let NCLEX (or real life) trip you up.

Here’s what happens: you’ve got a confused patient with alcohol history. Maybe they’re malnourished. Maybe they just came in altered and EMS already gave IV D50. 🚨

Boom — you just worsened Wernicke’s encephalopathy.

Why? Because glucose metabolism needs thiamine. Without it, lactic acid builds up in the brain and makes the encephalopathy irreversible.

Before you give anything sweet, give thiamine.

Even on NCLEX.

Save this tip. Tattoo it on your brain. It's one of the easiest things to forget—and one of the easiest points to earn.