Reye syndrome

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)

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]
  • 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

• Encephalitis
• Intracranial Hemorrhage
• Hepatitis
• Meningitis