{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:21:37Z","timestamp":1787721697701,"version":"build-2784847793"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>The coexistence of diabetic ketoacidosis (DKA) and severe acute pancreatitis (SAP) is a life-threatening metabolic emergency complicated by multiple organ dysfunction syndrome. The sequential development of Guillain-Barr\u00e9 syndrome (GBS) and Wernicke\u2019s encephalopathy (WE) in such critically ill patients is exceedingly rare and prone to missed diagnosis. A 26-year-old obese male was admitted with unconsciousness after excessive cola ingestion. He was diagnosed with DKA, SAP, pneumonia, sepsis. During hospitalization, the patient developed progressive visual impairment, dysphagia, hoarseness, and ophthalmoplegia. Neurological examination revealed diminished to absent tendon reflexes. Typical albumin-cytologic dissociation was detected in cerebrospinal fluid. Cranial magnetic resonance imaging showed characteristic hyperintense signals in the mammillary bodies and periaqueductal region, accompanied by reduced serum vitamin B1 levels, consistent with WE. The patient was eventually diagnosed with overlapping GBS and WE. He received repeated intravenous immunoglobulin therapy and thiamine supplementation. The patient\u2019s neurological function gradually recovered and he was discharged in stable condition. Critical illness-related systemic inflammation, metabolic derangements and infection can induce GBS, while inadequate thiamine supplementation and heightened consumption result in severe thiamine deficiency complicated by WE. Close neurological monitoring, timely thiamine supplementation, and standardized immunotherapy contribute to favorable clinical outcomes.<\/jats:p>","DOI":"10.3389\/fendo.2026.1923806","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:49:14Z","timestamp":1787719754000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A rare case of concurrent diabetic ketoacidosis and severe acute pancreatitis, followed by Guillain-Barr\u00e9 syndrome and Wernicke\u2019s encephalopathy"],"prefix":"10.3389","volume":"17","author":[{"given":"Chanjuan","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Clinical Nutrition, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youjin","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Radiology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyu","family":"Lin","sequence":"additional","affiliation":[{"name":"West China School of Medicine, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxin","family":"Zhang","sequence":"additional","affiliation":[{"name":"West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Guo","sequence":"additional","affiliation":[{"name":"West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziqi","family":"Lin","sequence":"additional","affiliation":[{"name":"West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1038\/s41572-020-0165-1","article-title":"Diabetic ketoacidosis","volume":"6","author":"Dhatariya","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-9032","article-title":"Hyperglycemic crises in adult patients with diabetes","volume":"32","author":"Kitabchi","year":"2009","journal-title":"Diabetes Care"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)31310-6","article-title":"Acute pancreatitis","volume":"396","author":"Boxhoorn","year":"2020","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.03188.x","article-title":"Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA","volume":"95","author":"Nair","year":"2000","journal-title":"Am J Gastroenterol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.813083","article-title":"Diabetic ketoacidosis with acute pancreatitis in patients with type 2 diabetes in the emergency department: a retrospective study","volume":"9","author":"Ma","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2147\/dmso.S336619","article-title":"Clinical characteristics of concomitant diabetic ketoacidosis in type 2 diabetes patients with acute pancreatitis","volume":"15","author":"Fu","year":"2022","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000014378","article-title":"The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. 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