Reye syndrome

Background

  • Potentially fatal syndrome
  • Effects to many organs, especially the brain and liver
  • Associated with aspirin taken for viral illness
  • Classic Early Symptoms:
    • Rash
    • Vomiting
    • Liver damage
  • Jaundice is not usually present[1]

Clinical Features

  • Five Stages[2]
    • 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 but still present hepatic dysfunction
    • Stage V
      • Deep coma
      • Seizures
      • Multiple organ failure[7]
      • Flaccidity
      • Hyperammonemia (above 300mg/dL of blood)
    • Death

Differential Diagnosis

Evaluation

  • CBC
  • Chem 10
  • ABG
  • Liver Panel
  • Ammonemia
  • Acetaminophen Level
  • ASA Level
  • Fingerstick (can be hypoglycemic)
  • Urine Tox
  • LP
  • ECG
  • EEG (coma)

Management

ABCs

  • Consider Intubation with Stage II
  • Ensure IV access with fluid resus
  • Aggressive cerebral edema monitoring and treatment

Consultations

  • Consider NSG Consult for Cerebral Edema
  • Consider GI consult for liver biopsy
  • Consider Metabolic Disorders

Also See

References

  1. Suchy, FJ, el al.; Sokol, RJ; Balistreri, WF (2007). Liver Disease in Children. Cambridge: Cambridge University Press. ISBN 0-521-85657-4.
  2. http://emedicine.medscape.com/article/803683-overview