Reye's Syndrome Symptoms and Risks

Reye's syndrome (RS) is a rare but potentially life-threatening condition that affects the brain and liver, causing vomiting, seizures, confusion, personality changes, and loss of consciousness.

Children are almost exclusively affected, with 90% of cases occurring after a child is given aspirin to treat a viral infection like the flu or chickenpox. For this reason, experts advise against the use of aspirin in children or teens who have either of these illnesses.

RS is treated as a medical emergency with the risk of death hovering between 20% and 40%.

This article describes the symptoms and causes of Reye's syndrome, including how this rare but deadly condition is diagnosed and treated.

What Are the Signs and Symptoms of Reye's Syndrome?

Reye's syndrome typically occurs when a viral infection like the flu (influenza) or chickenpox (varicella virus) is almost over and the child is starting to recover.

RS is characterized by the rapid build-up of ammonia in the bloodstream that leads to severe encephalopathy (brain swelling). The liver is also affected, causing rapid organ failure but usually without jaundice (the yellowing of the skin and eyes).

The symptoms of RS typically develop 3 to 5 days after the start of an infection like the flu or chickenpox and progress in five characteristic stages:

First Stage

• Headaches
• Loss of energy
• Lethargy
• Nausea and vomiting
• Drowsiness
• Rash on the palms of the hands and soles of the feet

Second Stage

• Personality changes such as irritability or aggressive behavior
• Restlessness
• Confusion or disorientation
• Deep lethargy and drowsiness
• Hyperventilation (rapid breathing)
• Tachycardia (rapid heartbeats)

Third Stage

• Unconsciousness
• Possible coma
• Possible seizures

Fourth Stage

• Deepening coma
• Seizures
• Rigidity
• Unresponsive pupils

Fifth Stage

• Seizures
• Deep coma
• Flaccidity (paralysis with loose limbs)
• Respiratory arrest
• Fixed, dilated pupils
• Multiple organ failure

What Is the Cause of Reye's Syndrome?

The cause of Reye's syndrome is unknown but it is strongly linked to the use of aspirin (salicylates) to treat upper respiratory infections in kids. Adults are rarely affected.

In the 1960s and 1970s, as many as 500 children in the United States were affected each year by Reye's syndrome. As many as two of every five cases resulted in death. Of those who survived, significant brain damage was common.

With parents warned against the use of aspirin in children and teens, the incidence of RS in the United States has dropped to only around two cases per year. Most cases occur during flu season, primarily the months of January, February, and March.

Reye's syndrome is not contagious.

How Is Reye's Syndrome Diagnosed?

The diagnosis of Reye's syndrome is based on the symptoms and the timing of symptoms (particularly if aspirin was used).

Lab tests can be used to support the diagnosis, including:

• Liver function tests (LFTs)
• Serum ammonia

Other illnesses have symptoms similar to Reye's syndrome, so healthcare providers may order additional tests to rule out other causes, such as:

• Viral encephalitis
• Meningitis
• Drug overdose
• Acute liver failure
• Acute kidney failure
• Shake baby syndrome

How Is Reye's Syndrome Treated?

Reye's syndrome almost always involves care in an intensive care unit (ICU). To relieve encephalitis, a type of sugar called mannitol may be delivered intravenously (into a vein) to help lower ammonia levels along with cerebral edema (build-up of fluid in the brain).

The treatment of Reye's syndrome is mainly supportive and often includes:

• Oxygen therapy
• Mechanical ventilation with intubation
• IV fluids to treat dehydration caused by severe vomiting
• Diuretics ("water pills") to ease high blood pressure and cerebral edema

How to Prevent Reye's Syndrome

Since aspirin is strongly linked to Reye's syndrome, the National Reye's Syndrome Foundation, the U.S. Surgeon General, the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC) advise against the use of aspirin in children or teens with the flu or chickenpox.

This not only includes aspirin brands but also aspirin-containing products.

Medications to avoid include:

• Bayer aspirin
• St. Joseph aspirin
• Anacin
• Excedrin
• Dristan
• Pamprin
• Pepto-Bismol
• Vanquish

Summary

Reye's syndrome is a rare condition affecting the brain and liver that mainly affects children recovering from a viral illness who have taken aspirin. Symtoms range from headache, personality changes, and vomiting to seizures, unconsciousness, and coma.

The risk of death is high with RS; children who survive often have brain damage. The risk of RS is greatly reduced by avoiding aspirin in children and teens with flu or chickenpox.