What is Reye’s Syndrome?
Reye’s syndrome is a disorder that affects all organs but mostly the brain and liver. The cause is unknown but it usually occurs in children (ages 4-14) recovering from a viral infection. It has been consistently observed that children who got this illness were given aspirin. Since this link was discovered, cases have dropped dramatically.
What are the Symptoms?
Reye’s syndrome has essentially two phases. The first phase is the viral infection (prodromal illness), such as gastroenteritis or upper respiratory infection. The second phase normally starts as the child appears to be recovering from the infection. The child develops recurrent, intractable vomiting and 24-48 hours later, behavioral changes appear, including irrational behavior, disorientation, delirium, hallucinations, and combativeness (which may alternate with lethargy and stupor).
What are the Stages?
The following stages have been developed to help evaluate progress and predict a probable outcome:
• Stage I: vomiting, lethargy, difficult to arouse
• Stage II: disorientation, delirium, combativeness, hyperventilation (or sometimes shallow breathing), hyperactive reflexes, stupor
• Stage III: decorticate posturing, hyperventilation, coma
• Stage IV: deepening coma, decerebrate posturing (rigidity), loss of ocular reflexes, fixed and dilated pupils
• Stage V: seizures, loss of reflexes, flaccidity, respiratory arrest
Clinical features are somewhat different in children less than 1 year of age. The prodromal illness is normally followed by mild (or no) vomiting, marked seizure activity, and respiratory disturbances (mostly hyperventilation).
What Abnormal Lab Values Can Occur?
The following are some abnormal lab values with Reye’s syndrome:
- elevated serum ammonia (indicating renal dysfunction)
- elevated SGOT and SGPT (indicating liver dysfunction)
- prolonged clotting factors (PT and PTT)
- low serum glucose (hypoglycemia).
How is Reye’s Syndrome Treated?
Reye’s syndrome is a serious medical condition that normally requires hospitalization.
Treatment is supportive, including maintaining adequate glucose levels, correcting acid-base imbalances, and controlling cerebral edema (swelling in the brain). Treatment is aimed toward normalizing organ function and protecting the brain from irreversible damage.
What is Reye’s Syndrome Prognosis?
The earlier the child is treated, the better the prognosis. Those in late stages are at high risk of brain damage and death. The overall mortality rate is about 20% (an improvement from earlier studies indicating 40-80%).
What Can You Do to Help Prevent Reye’s Syndrome?
Do not give a child aspirin (or other products like Pepto-Bismol that contain the compounds found in aspirin called salicylates) unless instructed by a doctor.
If aspirin is necessary, take measures to reduce the child’s risk of developing a viral infection.
Aspirin should not be given to a child for several weeks after receiving a chickenpox vaccine.
What Medications Can be Used Instead of Aspirin?
Acetaminophen (like Tylenol), ibuprofen (like Motrin), and naproxen sodium (like Aleve) are considered safe for children.
Whaley and Wong, Essentials of Pediatric Nursing, 2nd Edition (1985)
The Lippincott Manual of Nursing Practice, 4th Edition (1986)
Kids Health: Reye Syndrome - https://kidshealth.org/parent/system/medicine/reye.html
Medline Plus: Reye Syndrome - https://www.nlm.nih.gov/medlineplus/ency/article/001565.htm
Image of aspirin courtesy of https://en.wikipedia.org/wiki/File:Regular_strength_enteric_coated_aspirin_tablets.jpg