Reye Syndrome

Topic Overview

What is Reye syndrome?

Reye syndrome is a rare but serious disease that most often affects children ages 6 to 12 years old. It can cause brain swelling and liver damage. It may be related to using aspirin to treat viral infections.

Reye syndrome can lead to brain damage, liver damage, and death. But if the disease is diagnosed and treated early, most children recover from Reye syndrome in a few weeks and have no lasting problems.

What causes Reye syndrome?

Experts don't know what causes Reye syndrome. It often happens in children who have recently had chickenpox (varicella) or flu (influenza) and who took medicines that contain aspirin.

Reye syndrome cannot be spread from child to child (is not contagious).

What are the symptoms?

Reye syndrome often starts when a child is recovering from a viral infection, such as the flu or chickenpox, and has been treated with aspirin products. Symptoms usually develop 3 to 7 days after the viral illness starts. The symptoms develop over several hours to a day or two.

The first symptoms may include:

Sudden retching or vomiting.
Lack of energy and loss of interest in things.
Strange behavior, such as staring, irritability, personality changes, and slurred speech.
Sleepiness.

As brain damage gets worse, other symptoms may develop, including:

Confusion. Your child may not know where he or she is, recognize family or friends, or be able to answer simple questions.
Rapid, deep breathing (hyperventilation).
Violent behavior, such as hitting others without reason.
Seizures and coma.

If Reye syndrome is not treated quickly, it can cause death.

If your child has symptoms of Reye syndrome, get medical care right away. Early treatment makes full recovery more likely.

How is Reye syndrome diagnosed?

Your doctor will do a physical exam and ask questions about any past health problems.

Your doctor might look for Reye syndrome if:

Your child has recently had a viral illness such as the flu or chickenpox and has taken medicine that contains aspirin.
Your doctor sees a change in your child’s mental status (such as confusion) and has found liver problems.
The symptoms are not caused by other diseases or problems, such as kidney failure or problems with metabolism.

Your doctor may use lab tests such as blood and urine tests, a liver biopsy, a CT scan of the head, and a lumbar puncture (spinal tap).

How is it treated?

Reye syndrome is always treated in a hospital, often in the intensive care unit (ICU). Your child will be watched carefully by the hospital staff. The goal is to stop damage to the brain and liver and to prevent other problems.

Your child:

Will receive medicines to reduce brain swelling.
May receive fluids through a vein.
May have his or her kidney function checked by having a tube (catheter) placed in the bladder to drain urine into a collection bag.

Reye syndrome can be scary for you and your child. Remember that most children recover with no problems. To help yourself and your child feel better:

Talk with your doctor and the hospital staff about any questions or concerns you have about your child's care.
Stay with your child or visit often if you are not allowed to stay with your child in the ICU.
Let your child have some favorite toys or belongings while in the hospital. This will help your child feel more secure.

Can Reye syndrome be prevented?

The most important step you can take to prevent Reye syndrome is to not give aspirin or any product that contains aspirin to anyone younger than age 20 unless a doctor has prescribed it.

Aspirin is found in many over-the-counter medicines. Read labels carefully before giving medicine to your child. Aspirin is also called:

Acetyl salicylate.
Acetylsalicylic acid.
Salicylic acid.
Salicylate or subsalicylate.

If your child is taking aspirin and gets chickenpox or the flu, call your doctor right away.

Frequently Asked Questions

Learning about Reye syndrome:	What is Reye syndrome? What causes it? What are the symptoms?
Being diagnosed:	How is Reye syndrome diagnosed?
Getting treatment:	How is it treated? Is there home treatment for Reye syndrome?

Symptoms

Often, symptoms of Reye syndrome appear during recovery from a viral infection, such as the flu (influenza) or chickenpox (varicella). The symptoms develop rapidly over several hours to a day or two.

The first symptoms may include:

Sudden onset of retching or vomiting that is not clearly due to stomach flu.
Sluggishness, lack of energy, and loss of interest in surroundings.
Strange behavior, such as staring, irritability, personality change, and slurred speech.
Drowsiness that may lead to severe sleepiness (stupor).

As brain damage progresses, other symptoms may develop, including:

Confusion and inability to identify whereabouts or family members or to answer simple questions (disorientation).
Rapid, deep breathing (hyperventilation).
Aggressive behavior, such as hitting others without reason (combativeness).
Seizures and abnormal body positioning, and coma.

If Reye syndrome is not recognized and treated promptly, death can occur.

Before a diagnosis of Reye syndrome is made, other conditions with similar symptoms may be considered, because Reye syndrome is so rare.

Exams and Tests

Reye syndrome is diagnosed based on a medical history, a physical exam, and lab tests, if needed. In general, a diagnosis of Reye syndrome is considered if:

A child has recently had a viral illness such as flu or chickenpox and has taken medicine that contains aspirin.
A change in mental status (such as confusion) is noticed and liver problems are identified.
There is no evidence to suggest that symptoms are caused by other diseases or conditions, such as kidney failure or problems with metabolism.

Lab tests to diagnose Reye syndrome include:

Analysis of blood and urine samples to evaluate liver function and to measure blood sugar (glucose) levels. These tests also help to rule out other medical problems as a cause of symptoms.
A CT scan of the head to check for an injury or bleeding.
A spinal tap (lumbar puncture) to check for infection in the spinal fluid and to measure the pressure of the fluid within the spinal column. This test is not specific for diagnosing Reye syndrome. It is often done to eliminate other causes for the symptoms, such as brain and spinal infections.
A liver biopsy, in which a sample of liver tissue is removed for examination under a microscope. This is the most accurate test to diagnose Reye syndrome, although it is not always used because it can cause complications.

Treatment Overview

If your child has symptoms of Reye syndrome, seek medical care immediately. Early diagnosis and treatment helps to prevent serious complications and gives your child a better chance at a full recovery.

If caught early, most children with Reye syndrome recover and do not have any lasting problems. But others may develop serious complications, such as brain damage, or even die if the disease is severe.

Treatment is designed to stop brain and liver damage and prevent complications. Although Reye syndrome can range from mild to very serious, all children with it need to be hospitalized, usually in an intensive care unit. During hospitalization, a child:

May be given fluids through a vein (no fluids by mouth) for several days.
Will have his or her blood pressure, temperature, and pulse (vital signs) monitored very closely.
May have his or her kidney function checked by having a tube (catheter) placed in the bladder to drain urine into a collection bag.
Will have blood samples taken frequently to measure the amount of sugar (glucose) and other chemicals in his or her blood.
Will be given medicines to reduce brain swelling.

If a child becomes seriously ill or is in a coma, treatment will include:

Monitoring pressure inside the head to help prevent brain damage.
Using a respirator if the child is having severe difficulty breathing.

Being hospitalized for Reye syndrome can be a frightening experience for both you and your child. Discuss with the hospital health professionals any questions or concerns you have about your child's care.

If you are not allowed to stay with your child in the intensive care unit, visit frequently.
Let your child have some favorite toys or belongings while in the hospital. This will help your child feel more secure.

Home Treatment

Home treatment is not appropriate if your child has symptoms of Reye syndrome. Get medical care immediately, even if your child has not had a recent viral infection or taken aspirin. Early medical treatment lowers the risk of long-term complications and death.

You can help prevent Reye syndrome. Because there is a strong link between the use of aspirin in children and the development of Reye syndrome, do not give aspirin or products that contain aspirin to anyone younger than 20 unless directed by a doctor. This is especially important if the child has chickenpox (varicella) or the flu (influenza).

Aspirin is found in many over-the-counter medicines. Read labels carefully before giving medicine to your child. Aspirin is also called:

Acetyl salicylate.
Acetylsalicylic acid.
Salicylic acid.
Salicylate or subsalicylate.

These aspirin products are found in Pepto-Bismol, Kaopectate, and Alka Seltzer, for instance.

Certain childhood illnesses, such as juvenile rheumatoid arthritis, may require aspirin as part of the treatment. But give aspirin to a child only with direction from your doctor.

If your child is taking aspirin and gets chickenpox (varicella) or the flu (influenza), contact your doctor immediately.

A child who is hospitalized for Reye syndrome may take several weeks to recover after returning home. While caring for your child, ask relatives or reliable babysitters to periodically relieve you. Get recommendations from your doctor if you need additional help. You will be better able to help your child if you are not overtired.

Other Places To Get Help

Organizations

National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone:	1-800-352-9424 (301) 496-5751
TDD:	(301) 468-5981
Web Address:	www.ninds.nih.gov

The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders.

American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone:	(847) 434-4000
Fax:	(847) 434-8000
E-mail:	kidsdocs@aap.org
Web Address:	www.aap.org

The American Academy of Pediatrics (AAP) offers a variety of educational materials, such as links to publications about parenting and general growth and development. Immunization information, safety and prevention tips, AAP guidelines for various conditions, and links to other organizations are also available.

KidsHealth for Parents, Children, and Teens
10140 Centurion Parkway North
Jacksonville, FL 32256
Phone:	(904) 697-4100
Fax:	(904) 697-4125
Web Address:	www.kidshealth.org

This Web site is sponsored by the Nemours Foundation. It has a wide range of information about children's health, from allergies and diseases to normal growth and development (birth to adolescence). This Web site offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly e-mails about your area of interest.

National Reye's Syndrome Foundation
426 North Lewis Street
Bryan, OH 43506
Phone:	1-800-233-7393 (419) 924-9000
Fax:	(419) 924-9999
E-mail:	nrsf@reyessyndrome.org
Web Address:	www.reyessyndrome.org

The National Reye's Syndrome Foundation (NRSF) is a citizen group with a scientific advisory board. NRSF provides information about the risks of using aspirin and other salicylates. The group strives to raise awareness about early detection and support families affected by Reye's syndrome. The Web site has a list of ingredients to avoid during viral infections.

Related Information

References

Other Works Consulted

Brown LW (2006). Reye syndrome. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 417–420. Philadelphia: Saunders Elsevier.

Hurwitz E (2004). Reye syndrome. In R Feigin, J Cherry, eds., Textbook of Pediatric Infectious Diseases, vol. 1, pp. 682–684. Philadelphia: Saunders.

Sokol RJ, Narkewicz MR (2007). Reye syndrome (encephalopathy with fatty degeneration of the viscera) section of Liver and pancreas. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 663–664. New York: McGraw-Hill.

Credits

Author	Debby Golonka, MPH
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Last Updated	September 18, 2008

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