Reye syndrome

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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, and liver damage
  • Jaundice is not usually present[1]

Clinical Presentation

  • Five Stages[2]
    • Stage I
      • Rash on palms of hands and feet
      • Persistent, heavy vomiting
      • AMS, 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 300 mg/dL of blood)
    • Death

DDx

Management

  • ABCs
    • Consider Intubation with Stage II
  • IV access with fluid resus
  • Fingerstick
    • hypoglycemic - dextrose 25% bolus of 1-2 mL/kg
  • CBC
  • Chem 10
  • ABG
  • EKG
  • Liver Panel
  • Ammonemia
    • aggressive cerebral edema monitoring and treatment
  • LP
  • Urine Tox
  • Acetaminophen Level
  • ASA Level
  • EEG (coma)
  • Consider Central Line
  • Consider NSG Consult for Cerebral Edema
  • Consider GI consult for liver biopsy
  • Consider Metabolic Disorders

Also See

Sources

  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
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