Reye'S Syndrome

1 What is Reye's Syndrome?

A rare and serious condition that causes swelling in the liver and brain is called Reye’s (Ryes) syndrome.

Reye’s syndrome is a life-threatening condition hence early diagnosis and treatment can save the person life. Children and teenagers recovering from a viral infection, most common the flu or chickenpox, are among the often affected by Reye’s syndrome.

Some signs and symptom of Reye’s syndrome require that the child be brought to the hospital for emergency care, this include: loss of consciousness, confusion and seizures.

Aspirin is commonly used to treat this condition for children older than age 2, children and teenagers but it has be administered cautiously as it have adverse effect.

Also, Aspirin should not be given if the child has flu-like symptoms or is recovering from chickenpox. You must work closely with your doctor for any concerns or changes in your child that may or may not be related to Reye’s syndrome.

Reye's Syndrome

2 Symptoms

The signs and symptoms of Reye's syndrome typically appear about three to five days after the onset of:

  • a viral infection, such as the flu (influenza) or chickenpox,
  • an upper respiratory infection, such as a cold.

Initial signs and symptoms For children younger than age 2, the first signs of Reye's syndrome may include: Diarrhea Rapid breathing For older children and teenagers, early signs and symptoms may include: Persistent or continuous vomiting and unusual sleepiness or lethargy.

Additional signs and symptoms of the condition may mean that it has progressed and may need immediate medical attention, such as Irritable, aggressive or irrational behavior Confusion, disorientation or hallucinations Weakness or paralysis in the arms and legs Seizures Excessive lethargy Decreased level of consciousness.

These signs and symptoms are due to the fact that with Reye’s syndrome, a child's blood sugar level typically drops while the levels of ammonia and acidity in his or her blood rise. At the same time, the liver may swell and develop fatty deposits.

Swelling may also occur in the brain, which can cause seizures, convulsions or loss of consciousness. It is imperative that you become knowledgeable of the different signs and symptoms of Reye’s syndrome as early detection and treatment can save the child’s life.

Hence, any suspicions or concerned changes that may be related to some of the signs and symptoms would be best consulted to a doctor.

If the child experiences seizures or convulsions, and even loss of consciousness, emergency medical treatment is necessary. Also, if your child becomes unusually lethargic or sleepy, has sudden behavior changes and vomits repeatedly especially after a flu or chickenpox then urgently contact your doctor.

3 Causes

There are several factors that lead to the development or Reye’s syndrome, although the exact cause is still unknown. Reye’s syndrome seems to be aggravated by the use of aspirin in the treatment of a viral infection or illness, specifically flu (influenza) and chicken pox, in children and teenagers who have an underlying fatty acid oxidation disorder.

A screening test is needed to determine if your child has a fatty acid oxidation disorder. Fatty acid oxidation disorders are a group of inherited metabolic disorders in which the body is unable to break down fatty acids because an enzyme is missing or not working properly.

In some cases, presence of an underlying metabolic condition that’s unmasked by a viral infection lead to the development of Reye’s syndrome.

Other factors that contribute to the development of Reye’s syndrome is exposure to certain toxins such as insecticides, herbicides and paint thinner.

4 Making a Diagnosis

Reye’s syndrome may manifest in its more advanced stage as seizures or loss of consciousness will prompt emergency medical care and may lead to the diagnosis of the condition. Although, early signs and symptoms can also prompt seeking of medical appointment.

You'll likely be referred to a doctor who specializes in conditions of the brain and nervous system (neurologist). You must come prepared prior to your appointment to have a better understanding of Reye’s syndrome and the needed treatment.

Here are some things to ready prior to the appointment:

  • Be aware of any pre-appointment restrictions, ask if there is something that you would need to do in advance before the appointment.
  • Write down any symptoms your child is experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of all medications, including vitamins, dietary supplements and over-the-counter drugs, that your child has taken, especially any containing aspirin.
  • Even better, take the original bottles and a written list of the dosages and directions.
  • Have a family member or a friend accompany you and your child, if possible, as they will be able to offer emotional support and help retain pertinent information related to the condition, needed care and treatment of the child.

Prepare questions to ask the doctor such as:

  • What are other possible causes for my child's symptoms?
  • What tests are needed to confirm the diagnosis?
  • What are the treatment options and the pros and cons for each?
  • What results can I expect?
  • What kind of follow-up should I expect?

Do not be afraid to ask your doctor follow-up questions especially if a topic is confusion to you. The neurologist is likely to ask about your child's symptoms and history of viral illnesses. There's no specific test for Reye's syndrome.

The doctor will also conduct a medical exam and schedule tests to gather information about your child's condition and to rule out other diseases, such as meningitis or encephalitis.

Screening for Reye's syndrome usually begins with blood and urine tests as well as testing for fatty acid oxidation disorders and other metabolic disorders.

Oftentimes more-invasive diagnostic tests are needed to evaluate other possible causes of liver problems and investigate any neurological abnormalities. Other diagnostic tests that would soon follow the physical exam and medical history taking include:

(a) A head CT or MRI scan can help the doctor identify or rule out other causes of behavior changes or decreased alertness. A CT scan uses a sophisticated imaging machine linked to a computer to produce detailed, 2-D images of the brain. An MRI scan uses a strong magnetic field and radio waves rather than X-rays to generate images of the brain. Skin biopsy. Testing for fatty acid oxidation disorders or metabolic disorders may require a skin biopsy. During a skin biopsy, a doctor takes a small skin sample (biopsy) for analysis in a lab. A biopsy can usually be done in a doctor's office using a local anesthetic.

(b) A spinal tap or lumbar puncture can help the doctor identify or rule out other diseases with similar signs and symptoms, such as infection of the lining that surrounds the brain and spinal cord (meningitis) or inflammation or infection of the brain (encephalitis). During a spinal tap, a needle is inserted through the lower back into a space below the end of the spinal cord. A small sample of cerebrospinal fluid is removed and sent to a lab for analysis. Liver biopsy. A liver biopsy can help the doctor identify or rule out other conditions that may be affecting the liver. During a liver biopsy, a needle is inserted through the skin on the upper right side of the abdomen and into the liver. A small sample of liver tissue is removed and sent to a lab for analysis.

5 Treatment

Treatment of Reye’s syndrome would need to be done by licensed medical practitioners and would need to be in a hospital setting.

Severe cases may even need to be in the intensive care unit for closer monitoring of the afflicted. Blood pressure and other vital signs will be closely monitored by the hospital staff and prompt medical intervention will be provided as necessary.

Specific treatment is aimed at decreasing intracranial pressure and increasing fluid loss through urination, hence such treatments are as follows:

  • Intravenous fluids such as Glucose and an electrolyte solution via an intravenous (IV) line as well as Diuretics might be administered.
  • Vitamin K, plasma and platelet treatments may also be given to prevent bleeding caused by liver abnormalities.
  • A breathing machine (ventilator) will be provided as assistance if your child will have trouble breathing.

6 Prevention

The best method to prevent Reye's syndrome is to address other conditions early on.

Some hospitals and medical facilities conduct newborn screenings for fatty acid oxidation disorders to determine which children are at greater risk of developing Reye's syndrome.

Children with known fatty acid oxidation disorders should not take aspirin or aspirin-containing products. Although aspirin is approved for use in children older than 2 years old, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin.

Hence, necessary precautions should be taken in administering Aspirin to children and teenagers. Always check the label before you give your child medication, including over-the-counter products and alternative or herbal remedies.

Aspirin can show up in some unexpected places, such as Alka-Seltzer. Sometimes aspirin goes by other names, too, such as:

  • Acetylsalicylic acid
  • Acetylsalicylate Salicylic acid
  • Salicylate

There's one caveat to the aspirin rule, however. Children and teenagers who have certain chronic diseases, such as Kawasaki disease, may need long-term treatment with drugs that contain aspirin.

If your child needs aspirin therapy, make sure his or her vaccines are current — including two doses of the varicella (chickenpox) vaccine and a yearly flu vaccine. Avoiding these two viral illnesses can help prevent Reye's syndrome.

Other medications to reduce high fever or relieve pain, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Children's Motrin, Motrin IB, others) or naproxen (Aleve), should be used if your child has the flu, chickenpox or another viral illness.

7 Alternative and Homeopathic Remedies

There are no homeopathic or alternative remedies for Reye’s syndrome.

8 Lifestyle and Coping

To adjust your lifestyle in coping with Reye's syndrome, be careful with any medications you take as to not disrupt the liver.

Parents are urged to be cautious when using aspirin and aspirin substitutes such as Tylenol that contains acetaminophen because of the potential effect on the liver according to the Center for Disease Control and the National Academy of Pediatrics.

9 Risks and Complications

There are several risks associated with Reye's syndrome.

Without proper diagnosis and treatment, Reye's syndrome can be fatal within a few days. Most children and teenagers who have Reye's syndrome survive, although varying degrees of permanent brain damage are possible.

The following factors, usually when they occur together, may increase your child's risk of developing Reye's syndrome:

  • Using aspirin to treat a viral infection, such as flu, chickenpox or an upper respiratory infection.