Reyes syndrome

Reyes syndrome
Being stricken with Reye's syndrome is basically like being struck by lightning. It does not happen very often, but when it does, the consequences can be disastrous. For example, you would not send your child or teenager out to play on the beach with an aluminum baseball bat during a severe thunderstorm and you should not give your child aspirin. Never give anyone under 25 years of age aspirin for fever during flu, chicken pox, or any possible viral syndrome, or if they have liver damage.
Patients and their children should clearly understand this condition. They absolutely need to know that aspirin and salicylate-containing medicines are an extreme "No-No" for children and teenagers. One problem is that aspirin and its various forms such as Salicylate and Salicylic Acid is an ingredient in so many over-the-counter medications like Alka Seltzer and Pepto Bismol (Bismuth Salicylate). Teenagers should not be dosing themselves with anything, but they are notoriously known for doing so. The National Reye's Syndrome Foundation has a website with spoken and animated material directed towards these younger people on this subject.
An Australian pathologist named R. Douglas Reye first described the disease in 1962 after an outbreak of influenza B. He did not know what caused it, nor was it known until the late 1970's and early 1980's that aspirin was the medicine that was present in over 9 out of the 10 cases. The FDA began to warn against aspirin use in adolescents and teens in the 1980's. It was discovered that if they had been given aspirin for fever during the course of flu or chicken pox, about seven days later, they would start to act strangely as the brain begins to swell. They may be restless, lethargic, disoriented, or combative. They may be vomiting repeatedly without relief. The only signs in a youngster may be the lethargy, repeated vomiting, and rapid breathing. They may be repeatedly seizing. The problem is that if the parents do not tell the history of aspirin ingestion and the doctor does not have a high index of suspicion of Reye's syndrome, the symptoms can look like a lot of other problems. Brain infection (encephalitis), poisoning, meningitis, SIDS, or diabetes could all be considered as many other possibilities, until the patient volunteers a history of aspirin or an astute doctor asks that precise question. Prompt diagnosis of Reyes's syndrome is an absolute necessity as well as starting the proper life and brain-functioning treatments.
Although the syndrome can affect many other organs, the most severe affected organ other than the brain is the liver. The liver can have massive fat deposits within it that can cause it to shut down. This can be fatal. It is very important to do liver chemistry tests like SGOT and SGPT. In liver failure, the blood begins to have higher and higher levels of ammonia. This serum ammonia must be measured, followed, medicated correctly and re-checked. It is not known exactly what causes the problem in the liver, but it seems the tiny structures inside the liver cells, called mitochondria, malfunction. It is known that children with an inborn genetic error of metabolism, called fatty acid oxidation disorder, develop Reye's syndrome. Probably the liver cells lack a certain enzyme to process fatty acids, and this is what may happen. Specific tests for fatty acid oxidation disorder can be done to predict which children might be susceptible to Reye's syndrome.
The keys to minimizing damage from Reye's syndrome are first of all to make an early diagnosis and start proper therapy as soon as possible. Then the brain must be protected from having too little oxygen or glucose. Children are often placed on a ventilator to ensure adequate oxygen to the brain, as too little is the biggest threat for later brain damage. Blood glucose tends to run low during Reye's syndrome, so intravenous glucose and salt solutions are usually administered. Diuretics and other medicines are given to decrease brain swelling. The blood ammonia and liver function tests are carefully followed and specially treated. The child must be in an Intensive Care Unit where maximal protection against cardiac arrest is available. The best circumstance is for the child to be at a teaching center or at a children's hospital which is extremely familiar with the treatment of Reye's syndrome. The rehabilitation can be complex. Damage can be minimal to severe. Sometimes rehabilitation requires special schooling arrangements, speech therapy, physical therapy, and other modalities. The National Reye's Foundation has a website rich in information for maximizing life potential after Reye's syndrome illness.
One important message to remember about this syndrome.....Do not give your children aspirin or salicylates up through age 25. Teach your children to check with you before taking any medicines, and make them aware of the dangers of Reye's syndrome. Parents must be cautious of drugs with salicylates on the label. If your child has mental status changes, seizures or any other neurological symptoms during an illness or shortly after an illness, seek immediate medical care. If your child has intractable vomiting during an illness, do not give anti-nauseates, but seek medical care. Learn everything you can about Reye's syndrome, and be diligent about early warning signs. Remember, you don't take aspirin and breast feed, because the aspirin goes right into your milk. Ask your doctor if your child should be tested for fatty acid oxidative disorder. Keep all immunizations, including flu, up to date. If your child has fever during an illness, you can give Tylenol or Motrin exactly as they are directed. Together, doctors and wise parents can see a continuing decline in the incidence of this drastic illness.
John Drew Laurusonis, MD
Doctors Medical Center