Reye’s s syndrome is sudden (acute) brain damage (encephalopathy) and liver function problems of unknown causes. Reye’s syndrome is a rare and life-threatening condition that usually affects people from infancy through young adulthood. Although no age group is immune, Reye’s syndrome occurs mostly in children 4-12.
Most cases associated with chicken pox have been shown to occur in children age 5 to 9. Those associated with flu (influenzae type B) have occurred in children aged 10 to 14. The cause of Reye’s syndrome is unknown, but the disease usually follows an acute viral infection, particularly influenza or chicken pox, especially when aspirin or other salicylates have been given. The symptoms usually come about a week after the virus infection. Symptoms include vomiting and disorientation, which may be followed by seizures, coma and respiratory arrest.
The main targets of Reye’s syndrome are the liver and the brain. It is not contagious and is often misdiagnosed as meningitis, encephalitis, diabetes, drug overdose, poisoning or sudden infant death (SIDS).
Children with Reye’s syndrome get sick very suddenly. Immediate diagnosis is crucial. Anyone who has had any viral infection should be carefully watched during the 2 to 3 weeks following the infection. The following symptoms usually occur in this order:
• Relentless or continuous vomiting
• Listlessness (loss of pep and energy with little interest in anything)
• Drowsiness (excessive sleeping)
• Personality change (irritability, slurred speech, sensitivity to touch)
• Disorientation or confusion (unable to identify whereabouts, family members or answer questions)
• Combativeness
• Delirium, convulsions or loss of consciousness
• Unusual placement of arms and legs (the arms are extended straight and turned toward the body, the legs are held straight, and the toes are pointed downward)
• Weakness in arms or legs
• Loss of muscle function
• Double Vision
• Speech difficulties
• Hearing loss
Reye’s syndrome should be suspected in anyone who is experiencing repeated vomiting. See your physician or go to the emergency room immediately if any of the above symptoms develop.
Aspirin and any aspirin-containing medication and any anti-nausea medicines should never be used to treat flu, chicken pox or any viral illness. Anti nausea medicines may mask the symptoms of Reye’s syndrome. The National Reye’s Syndrome Association, the US Surgeon General, the Food and Drug Administration and the Centers for Disease Control and Prevention all recommend that aspirin and aspirin combination products not be taken by anyone under 19 years of age during fever-causing illnesses. Doctors recommend giving children acetaminophen (Tylenol) rather than aspirin for viral infections and fever.
Two liver function tests are available to determine the possibility of Reye’s syndrome (SGOT, SGPT). In addition, these other tests are used to diagnose Reye’s syndrome: blood chemistry, serum ammonia test, liver biopsy, spinal tap, head CT or head MRI scan.
Specific treatments have not been determined but intensive monitoring of the brain’s pressure, blood gases, and blood pH is essential. Treatments may include:
• Fluids by IV to provide electrolytes and glucose
• Steroids to reduce the swelling in the brain
• Breathing support (a ventilator may be needed during a deep coma)
The prognosis for patients with Reye’s syndrome depends on the severity of any coma as well as other factors. The average death rate appears to be about 40%. For patients who survive an acute episode, the survival rate is good. Complications of Reye’s syndrome include permanent brain damage and coma.
The prevention of this very serious disease is to never give a child aspirin unless specifically told to do so by your physician. Aspirin should be avoided for several weeks after receiving a varicella (chickenpox) vaccine.
Other over-the-counter medications such as Pepto-Bismol and compounds containing oil of wintergreen also contain aspirin-compounds called salicylates. These should not be given to a child who has a cold or fever.
