Reye syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Potentially fatal syndrome | *Potentially fatal syndrome | ||
* | *Associated with [[aspirin]] use during [[viral syndrome|viral illness]], especially [[influenza]], [[varicella]] | ||
*Multiorgan system disease, particularly effects brain and liver | |||
*Classic | *Classic early symptoms: [[rash]], [[vomiting]], [[liver failure|liver damage]] (without [[jaundice]] typically)<ref>Suchy, FJ, el al.; Sokol, RJ; Balistreri, WF (2007). Liver Disease in Children. Cambridge: Cambridge University Press. ISBN 0-521-85657-4.</ref> | ||
==Clinical | ==Clinical Features== | ||
*Stage I | |||
**[[Rash]] on palms of hands and feet | |||
** | **Persistent, heavy [[vomiting]] | ||
**[[Altered mental status]], [[confusion]], generalized [[lethargy]] | |||
** | **High [[fever]] | ||
*Stage II | |||
**Stupor | |||
**[[Hyperventilation]] | |||
** | **Fatty liver (found by biopsy) | ||
*Stage III | |||
**Possible [[coma]] | |||
**Possible cerebral edema | |||
**Rarely, [[respiratory arrest]] | |||
*Stage IV | |||
**Deepening [[coma]] | |||
**Dilated pupils with minimal response to light | |||
**Minimal hepatic dysfunction | |||
*Stage V | |||
**Deep [[coma]] | |||
**[[Seizures]] | |||
** | **Multisystem organ failure[7] | ||
** | **[[Weakness|Flaccidity]] | ||
** | **Hyperammonemia (above 300mg/dL of blood) | ||
*Death | |||
== | ==Differential Diagnosis== | ||
*[[Shaken baby syndrome]] | *[[Shaken baby syndrome]] | ||
*Head trauma | *[[Head trauma (peds)|Head trauma]] | ||
*[[Viral encephalitis]] | *[[Viral encephalitis]] | ||
*[[Meningitis]] | *[[Meningitis]] | ||
*Drug overdose or poisoning | *Drug overdose or poisoning | ||
* | *[[Inborn errors of metabolism]] | ||
== | ==Evaluation== | ||
*CBC | *CBC | ||
*Chem 10 | *Chem 10 | ||
*ABG | *ABG | ||
* | *[[LFTs]] | ||
*Ammonemia | *Ammonemia | ||
** | *[[Acetaminophen toxicity|Acetaminophen]] level (rule out coingestion/alternate cause of liver failure) | ||
* | *[[Salicylate toxicity|ASA]] level (rule out overdose) | ||
* | *Fingerstick (can be [[hypoglycemia|hypoglycemic]]) | ||
* | *[[UDS]] | ||
* | *[[LP]] | ||
*[[ECG]] | |||
*EEG (coma) | *EEG (coma) | ||
*Consider | |||
*Consider NSG Consult for | ==Management== | ||
===ABCs=== | |||
*Consider [[intubation]] if stage II or higher | |||
*Ensure IV access with fluid resus | |||
*Monitor neuro status closely, treat signs of cerebral edema aggressively | |||
===Consultations=== | |||
*Consider NSG Consult for cerebral edema | |||
*Consider GI consult for liver biopsy | *Consider GI consult for liver biopsy | ||
*Consider | *Consider metabolic disorders | ||
==Also See== | ==Also See== | ||
| Line 70: | Line 70: | ||
*[[Meningitis]] | *[[Meningitis]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Pediatrics]] | ||
Latest revision as of 15:32, 14 September 2019
Background
- Potentially fatal syndrome
- Associated with aspirin use during viral illness, especially influenza, varicella
- Multiorgan system disease, particularly effects brain and liver
- Classic early symptoms: rash, vomiting, liver damage (without jaundice typically)[1]
Clinical Features
- Stage I
- Stage II
- Stupor
- Hyperventilation
- Fatty liver (found by biopsy)
- Stage III
- Possible coma
- Possible cerebral edema
- Rarely, respiratory arrest
- Stage IV
- Deepening coma
- Dilated pupils with minimal response to light
- Minimal hepatic dysfunction
- Stage V
- Deep coma
- Seizures
- Multisystem organ failure[7]
- Flaccidity
- Hyperammonemia (above 300mg/dL of blood)
- Death
Differential Diagnosis
- Shaken baby syndrome
- Head trauma
- Viral encephalitis
- Meningitis
- Drug overdose or poisoning
- Inborn errors of metabolism
Evaluation
- CBC
- Chem 10
- ABG
- LFTs
- Ammonemia
- Acetaminophen level (rule out coingestion/alternate cause of liver failure)
- ASA level (rule out overdose)
- Fingerstick (can be hypoglycemic)
- UDS
- LP
- ECG
- EEG (coma)
Management
ABCs
- Consider intubation if stage II or higher
- Ensure IV access with fluid resus
- Monitor neuro status closely, treat signs of cerebral edema aggressively
Consultations
- Consider NSG Consult for cerebral edema
- Consider GI consult for liver biopsy
- Consider metabolic disorders
Also See
References
- ↑ Suchy, FJ, el al.; Sokol, RJ; Balistreri, WF (2007). Liver Disease in Children. Cambridge: Cambridge University Press. ISBN 0-521-85657-4.