View source for Reye syndrome

==Background==
*Potentially fatal syndrome
*Associated with [[aspirin]] use during [[viral syndrome|viral illness]], especially [[influenza]], [[varicella]]
*Multiorgan system disease, particularly effects brain and liver
*Classic early symptoms: [[rash]], [[vomiting]], [[liver failure|liver damage]] (without [[jaundice]] typically)<ref>Suchy, FJ, el al.; Sokol, RJ; Balistreri, WF (2007). Liver Disease in Children. Cambridge: Cambridge University Press. ISBN 0-521-85657-4.</ref>

==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]
**[[Weakness|Flaccidity]]
**Hyperammonemia (above 300mg/dL of blood)
*Death

==Differential Diagnosis==
*[[Shaken baby syndrome]]
*[[Head trauma (peds)|Head trauma]]
*[[Viral encephalitis]]
*[[Meningitis]]
*Drug overdose or poisoning
*[[Inborn errors of metabolism]]

==Evaluation==
*CBC
*Chem 10
*ABG
*[[LFTs]]
*Ammonemia
*[[Acetaminophen toxicity|Acetaminophen]] level (rule out coingestion/alternate cause of liver failure)
*[[Salicylate toxicity|ASA]] level (rule out overdose)
*Fingerstick (can be [[hypoglycemia|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]]

==References==
<references/>

[[Category:ID]]
[[Category:Pediatrics]]