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Highlights & Basics
- Reye syndrome is defined as acute encephalopathy with hepatic dysfunction stemming from mitochondrial damage.
- Etiology remains unknown, but viral infections, exogenous toxins, drugs, and inborn errors of metabolism have been implicated. Aspirin is classically associated but data are lacking for a definitive cause-effect relationship.
- Usually presents with acute onset of profuse vomiting and altered mental status, ranging from a personality change to coma, in children recovering from a recent viral infection.
- Laboratory findings include elevated ammonia, ALT/AST, and prolonged PT, without an increase in bilirubin. Liver biopsy shows steatosis without significant inflammation.
- Treatment includes intensive supportive care, correction of metabolic abnormalities, and control of intracranial pressure.
Quick Reference
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Definition
Epidemiology
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Pathophysiology
Citations
Centers for Disease Control and Prevention. Reye syndrome: 1990 clinical case definition. 1990 [internet publication].[Full Text]
Hurwitz ES, Nelson DB, Davis C, et al. National surveillance for Reye syndrome: a five-year review. Pediatrics. 1982 Dec;70(6):895-900.[Abstract]
Belay ED, Bresee JS, Holman RC, et al. Reye's syndrome in the United States from 1981 through 1997. N Engl J Med. 1999 May 6;340(18):1377-82.[Abstract][Full Text]
Royal College of Paediatrics and Child Health. Management of children and young people with an acute decrease in conscious level. Mar 2019 [internet publication].[Full Text]
Hardie RM, Newton LH, Bruce JC, et al. The changing clinical pattern of Reye's syndrome 1982-1990. Arch Dis Child. 1996 May;74(5):400-45.[Abstract]
1. Centers for Disease Control and Prevention. Reye syndrome: 1990 clinical case definition. 1990 [internet publication].[Full Text]
2. Hurwitz ES, Nelson DB, Davis C, et al. National surveillance for Reye syndrome: a five-year review. Pediatrics. 1982 Dec;70(6):895-900.[Abstract]
3. Kamienski MC. Reye syndrome. Am J Nurs. 2003;103:54-7.[Abstract]
4. Chang PF, Huang SF, Hwu WL, et al. Metabolic disorders mimicking Reye's syndrome. J Formos Med Assoc. 2000 Apr;99(4):295-9.[Abstract]
5. Belay ED, Bresee JS, Holman RC, et al. Reye's syndrome in the United States from 1981 through 1997. N Engl J Med. 1999 May 6;340(18):1377-82.[Abstract][Full Text]
6. Schror K. Aspirin and Reye syndrome: a review of the evidence. Paediatr Drugs. 2007;9(3):195-204.[Abstract]
7. Fitzgerald DA. Aspirin and Reye syndrome. Paediatr Drugs. 2007;9(3):205-6.[Abstract]
8. Casteels-Van Daele M, Van Geet C, Wouters C, et al. Reye syndrome revisited: a descriptive term covering a group of heterogeneous disorders. Eur J Pediatr. 2000 Sep;159(9):641-8.[Abstract]
9. Chapman J, Arnold JK. Reye syndrome. StatPearls Publishing; 2019.[Abstract][Full Text]
10. Khater F, Moorman JP. Complications of influenza. South Med J. 2003 Aug;96(8):740-3.[Abstract]
11. Hall SM, Plaster PA, Glasgow JF, et al. Preadmission antipyretics in Reye's syndrome. Arch Dis Child. 1988 Jul;63(7):857-66.[Abstract][Full Text]
12. Guy M, Nicoll A, Lynn R. British Paediatric Surveillance Unit. 12th annual report. London: Royal College of Paediatrics and Child Health; 1998. Surveillance activities in 1997;8-10.
13. Glasgow JF. Reye's syndrome: the case for a causal link with aspirin. Drug Saf. 2006;29(12):1111-21.[Abstract]
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15. Dinakaran D, Sergi CM. Co-ingestion of aspirin and acetaminophen promoting fulminant liver failure: A critical review of Reye syndrome in the current perspective at the dawn of the 21st century. Clin Exp Pharmacol Physiol. 2018 Feb;45(2):117-21.[Abstract][Full Text]
16. Moore DL; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Influenza vaccine recommendations for children and youth for the 2013/2014 season. Paediatr Child Health. 2013 Oct;18(8):e51-2.[Abstract][Full Text]
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18. Royal College of Paediatrics and Child Health. Management of children and young people with an acute decrease in conscious level. Mar 2019 [internet publication].[Full Text]
19. Coates PM. Inherited abnormalities in mitochondrial fatty acid oxidation. In: Walker W, ed. Pediatric gastrointestinal disease pathophysiology, diagnosis and management. 2nd ed. St Louis, MO: Mosby-Year Book; 1996:1163-81.
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21. The diagnosis and treatment of Reye's syndrome. Natl Inst Health Consens Dev Conf Summ. 1981;4(1):7.[Abstract]
22. Hardie RM, Newton LH, Bruce JC, et al. The changing clinical pattern of Reye's syndrome 1982-1990. Arch Dis Child. 1996 May;74(5):400-45.[Abstract]
23. Tein I. Disorders of fatty acid oxidation. Handb Clin Neurol. 2013;113:1675-88.[Abstract][Full Text]
24. Centers for Disease Control and Prevention. Reye syndrome: 1990 clinical case definition. 1990 [internet publication].[Full Text]
25. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2018 Aug 03;(2):CD000567.[Abstract][Full Text]
26. Abdel-Wahab OI, Healy B, Dzik WH. Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities. Transfusion. 2006 Aug;46(8):1279-85.[Abstract]
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28. Meekin S, McCusker C, Glasgow JF, et al. A long-term follow-up of cognitive, emotional, and behavioral sequelae to Reye's syndrome. Dev Med Child Neurol. 1999 Aug;41(8):549-53.[Abstract]
