Reye’s syndrome is a rapidly progressive encephalopathy

Reye’s syndrome is a rare but serious condition and often fatal. This condition causes swelling in the liver and brain. It most often affects children and teenagers recovering from a viral infection, most commonly the flu or chickenpox. Signs and symptoms such as confusion, seizures and loss of consciousness require emergency treatment. Early diagnosis and treatment of Reye’s syndrome can save a child’s life.

• Symptoms may include vomiting, personality changes, confusion, seizures and loss of consciousness.
• Even though liver toxicity typically occurs, yellowish skin usually does not.
• Death occurs in 20–40% of those affected and about a third of those who survive are left with a significant degree of brain damage.

Aspirin has been linked with Reye’s syndrome, so use caution when giving aspirin to children or teenagers for fever or pain. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin.

For the treatment of fever or pain, consider giving your child infants’ or children’s over-the-counter fever and pain medications such as acetaminophen (e.g. Tylenol) or Ibuprofen (Advil, Motrin, etc.) as a safer alternative to aspirin. Talk to your doctor if you have concerns.

Children and the first signs of Reye’s syndrome may include:

• Diarrhoea behaviour
• Rapid breathing

For older children and teenagers, early signs and symptoms may include:

• Persistent or continuous vomiting
• Unusual sleepiness or lethargy

Additional signs and symptoms

As the condition progresses, signs and symptoms may become more serious, including:

• Irritable, aggressive or irrational behaviour
• Confusion, disorientation or hallucinations
• Weakness or paralysis in the arms and legs
• Seizures
• Excessive lethargy
• Decreased level of consciousness

These signs and symptoms require emergency treatment.

When to see a doctor

Early diagnosis and treatment of Reye’s syndrome can save a child’s life. If you suspect that your child has Reye’s syndrome, it’s important to act quickly.

Seek emergency medical help if your child:

• Has seizures or convulsions
• Loses consciousness

Contact your child’s doctor if your child experiences the following after a bout with the flu or chickenpox:

• Vomits repeatedly
• Becomes unusually sleepy or lethargic

Risk factors

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
• Having an underlying fatty acid oxidation disorder

Prevention

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This includes plain aspirin and medications that contain aspirin.

• Computerized tomography (CT) scan or magnetic resonance imaging (MRI). A head CT or MRI scan can help the doctor identify or rule out other causes of behaviour changes or decreased alertness.

A CT scan uses a sophisticated imaging machine linked to a computer to produce detailed, 2D 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 anaesthetic.

Treatment

Reye’s syndrome is usually treated in the hospital. Severe cases may be treated in the intensive care unit. The hospital staff will closely monitor your child’s blood pressure and other vital signs. Specific treatment may include:

• Intravenous fluids. Glucose and an electrolyte solution may be given through an intravenous (IV) line.
• Diuretics. These medications may be used to decrease intracranial pressure and increase fluid loss through urination.
• Medications to prevent bleeding. Bleeding due to liver abnormalities may require treatment with vitamin K, plasma and platelets.
• Cooling blankets. This intervention helps maintain internal body temperature at a safe level.

If your child has trouble breathing, he or she may need assistance from a breathing machine (ventilator).