Reye syndrome is a rare illness that can affect the blood, liver, and brain of someone who has recently had a viral infection. It always follows another illness. Although it mostly affects children and teens, anyone can get it. It can develop quickly and without warning.
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NCBI Bookshelf. Jennifer Chapman ; Justin K. Authors Jennifer Chapman 1 ; Justin K. Arnold 2. Australian pathologist R. Reye syndrome typically presents in children as vomiting and confusion with rapid progression to coma and death. This syndrome often begins in the days following recovery from a viral illness during which aspirin was administered.
However, there is no test specific to Reye syndrome. Epidemiologic studies found a link between use of salicylate and development of Reye syndrome.
While less than 0. This data led to recommendations against the use of aspirin in children in The number of reported cases of Reye syndrome fell dramatically following the widespread warnings against the use of aspirin in children.
Reye syndrome is a rare diagnosis with fewer than 2 cases reported annually since Gender has not been reported as a risk factor. There is seasonal variation with the majority of cases being reported from December through April.
National surveillance of Reye syndrome began in The CDC reported cases between and The incidence fell from an average of cases per year in and to an average of 36 cases per year between and Incidence has fallen off sharply since with 0. In , the United Kingdon warned against the use of aspirin in children under the age of Following that warning, the incidence fell from 0. Similar declines were also observed in France.
It should be noted that aspirin remains a mainstay of treatment for children diagnosed with Kawasaki disease. The exact pathophysiology of Reye syndrome is not precisely known; however, it appears to involve mitochondrial injury in the setting of a viral illness.
The neurologic features of Reye syndrome likely result from hepatic mitochondrial dysfunction causing elevated ammonia levels. Hyperammonemia may induce astrocyte edema resulting in diffuse cerebral edema and subsequent elevated intracranial pressure.
A high level of suspicion based on the history of presenting illness, clinical signs and symptoms and laboratory findings are required to make this rare diagnosis. Signs and symptoms of Reye syndrome typically develop between 12 hours and 3 weeks after recovery from a viral illness such as upper respiratory tract infection or gastroenteritis.
The CDC has described clinical progression as 5 distinct stages:. Hepatopathy documented by either a a liver biopsy or an autopsy considered to be diagnostic of Reye syndrome or b a threefold or greater increased in the levels fo the serum glutamic-oxaloacetic transaminase SGOT , serum glutamic-pyruvic transaminase SGPT or serum ammonia. Lab abnormalities associated with Reye syndrome include elevated liver function tests ALT, AST, bilirubin , hyperammonemia, abnormal coagulation studies, elevated amylase, and lipase, decreased serum bicarbonate and lab values consistent with dehydration.
If lumbar puncture is performed to obtain CSF, the leukocyte count must be below 8 to meet diagnostic criteria. Reye syndrome is a rapidly progressing disease that may require invasive procedures early on to maintain hemodynamically stability and adequate respiratory function. These may include placement of central venous access, airway intubation, and placement of a Foley catheter to monitor urine output. Additional specialized procedures such as liver biopsy and intracranial pressure monitoring may also be indicated.
Treatment of Reye syndrome is mainly supportive and requires close monitoring of multiple clinical parameters best accomplished in an intensive care unit setting. Aggressive treatment may be required to correct the following serum abnormalities:.
Signs and symptoms of Reye syndrome should prompt strong suspicion and investigation for undiagnosed inborn errors of metabolism IEM. Given the high mortality of Reye syndrome despite treatment, the focus today is on prevention.
Besides physicians, the nurse and the pharmacist are in a prime position to educate the parents about risk factors for the disorder. Further, the parents should be educated about the symptoms and signs of Reyes syndrome and when to seek immediate help. The pharmacist should always speak to the family about the safe use of medications in children and alternative options for the management of fever and pain. By preventing increased intracranial pressure and edema, death can be avoided in many children.
For those who survive, full recovery has been noted in about two-thirds of patients. However, those children with elevated levels of ammonia usually have residual neurological deficits. To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4.
Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 Lahey Health Systems. Epidemiology Reye syndrome is a rare diagnosis with fewer than 2 cases reported annually since Pathophysiology The exact pathophysiology of Reye syndrome is not precisely known; however, it appears to involve mitochondrial injury in the setting of a viral illness.
History and Physical A high level of suspicion based on the history of presenting illness, clinical signs and symptoms and laboratory findings are required to make this rare diagnosis. The CDC has described clinical progression as 5 distinct stages: Stage 1 Persistent, copious vomiting. Hyperreflexia, positive Babinski sign, lack of appropriate response to noxious stimuli, dilated and sluggish pupils. Pupil dilation with minimal response to light or fixed and dilated pupils, deconjugate gaze with caloric stimuli.
No more reasonable explanation for the cerebral and hepatic abnormalities. Acidosis may be treated with sodium bicarbonate attention not to over correct or correct too rapidly and ventilation management. Differential Diagnosis Drug toxicity. Complications Seizures. Consultations Pediatrician. Pearls and Other Issues Signs and symptoms of Reye syndrome should prompt strong suspicion and investigation for undiagnosed inborn errors of metabolism IEM.
Enhancing Healthcare Team Outcomes Given the high mortality of Reye syndrome despite treatment, the focus today is on prevention. Questions To access free multiple choice questions on this topic, click here.
References 1. Acetylsalicylic acid as a potential pediatric health hazard: legislative aspects concerning accidental intoxications in the European Union. J Occup Med Toxicol. Crit Rev Anal Chem. Tasker RC. Update on pediatric neurocritical care. Paediatr Anaesth. An 8-year-old girl with abdominal pain and mental status changes. Pediatr Emerg Care.
Georgian Med News. Kramer MS. Kids versus trees: Reye's syndrome and spraying for spruce budworm in New Brunswick. J Clin Epidemiol. Aspirin increases mitochondrial fatty acid oxidation. Evaluation of presence of aspirin-related warnings with willow bark. Ann Pharmacother. The differential diagnosis of Reye syndrome: muscle biopsy evaluation. Brain Dev. Quantitative evaluation of the extent of hepatic enzyme changes in Reye syndrome compared with normal liver or with non-Reye liver disorders: objective criteria for animal models.
Belkengren RP, Sapala S. Reye syndrome: clinical guidelines for practitioners in ambulatory care. Pediatr Nurs. Ann Fr Anesth Reanim. Have the efforts to prevent aspirin-related Reye's syndrome fuelled an increase in asthma?
Epidemiology of Reye's syndrome, United States, comparison of CDC surveillance and hospital admission data. Ross-Degnan D. Changing behavior to maintain a healthy home. Reye's syndrome in the United States from through Maternal and child health epidemic-assistance investigations, Reye Syndrome. In: StatPearls [Internet]. In this Page. Related information.
Reye's Syndrome: Why Aspirin and Children Don't Mix
Reye's Reye syndrome is a rare but serious condition that causes swelling in the liver and brain. Reye's syndrome most often affects children and teenagers recovering from a viral infection, most commonly the flu or chickenpox. Signs and symptoms such as confusion, seizures and loss of consciousness require emergency treatment. Early diagnosis and treatment of Reye's syndrome can save a child's life. Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers for fever or pain. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin.
síndrome de Reye
NCBI Bookshelf. Jennifer Chapman ; Justin K. Authors Jennifer Chapman 1 ; Justin K. Arnold 2. Australian pathologist R.
Although it can happen at any age, it is most often seen in children. Both chickenpox and the flu can cause headaches. They generally appear over the course of several hours. This is followed by irritability or aggressiveness. After that, children may become confused and lethargic. They may have seizures or fall into a coma.