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Reye syndrome
From WikEM
Contents
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
- Stage I
Differential Diagnosis
- Shaken baby syndrome
- Head trauma
- Viral encephalitis
- Meningitis
- Drug overdose or poisoning
- Various inborn metabolic disorders
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
- ↑ Suchy, FJ, el al.; Sokol, RJ; Balistreri, WF (2007). Liver Disease in Children. Cambridge: Cambridge University Press. ISBN 0-521-85657-4.
- ↑ http://emedicine.medscape.com/article/803683-overview
Authors
Aaron Snyder, Neil Young, Ross Donaldson, Kevin Lu, Daniel Ostermayer
