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, and liver damage
• Jaundice is not usually present

Clinical Presentation

• Five Stages
  • 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

• Shaken baby syndrome
• Head trauma
• Viral encephalitis
• Meningitis
• Drug overdose or poisoning
• Various inborn metabolic disorders

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

• Encephalitis
• Intracranial Hemorrhage
• Hepatitis
• Meningitis

Sources

• Uptodate
• http://emedicine.medscape.com/article/803683-overview -- last accessed 1/4/15