Materiały źródłowe

• #1 Reye’s syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255

  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. […] A screening test can determine if your child has a fatty acid oxidation disorder. […] Without proper diagnosis and treatment, Reye’s syndrome can cause death within a few days.

• #1 Reye Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526101/

  Reye syndrome is a rare and potentially fatal pediatric illness defined as acute noninflammatory encephalopathy with fatty liver failure. […] This diagnosis is based on clinical signs as well as laboratory testing. However, there is no test specific to Reye syndrome. […] The CDC has defined Reye syndrome using the following criteria: „Acute noninflammatory encephalopathy that is documented clinically by a) an alteration in consciousness and, if available b) a record of cerebrospinal fluid (CSF) containing less than or equal to 8 leukocytes/cu.mm or a histologic specimen demonstrating cerebral edema without perivascular or meningeal inflammation. […] Lab abnormalities associated with Reye syndrome include elevated liver function tests (ALT, AST, bilirubin), hyperammonemia, abnormal coagulation studies, elevated amylase, and lipase, decreased serum bicarbonate and lab values consistent with dehydration. […] If lumbar puncture is performed to obtain CSF, the leukocyte count must be below 8 to meet diagnostic criteria.

• #1 Reye Syndrome | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/reye-syndrome

  The diagnosis of Reye syndrome is made after the sudden onset of specific symptoms and after diagnostic testing. During a physical examination, your child’s physician obtains a complete medical history. You may also be asked if your child has recently had a cold or other viral illness, and whether your child has taken aspirin or medication containing aspirin. […] Diagnostic tests that may be performed to confirm the diagnosis of Reye syndrome include the following: Blood- and liver-function tests, Urine and stool tests, Liver biopsy: A small amount of tissue removed from the liver and studied, Electroencephalogram (EEG): Records the brain’s continuous, electrical activity by means of electrodes attached to the scalp, Lumbar puncture (spinal tap): A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child’s brain and spinal cord. […] Intracranial pressure monitoring (ICP): Measures the pressure inside of the child’s head.

• #1 Reye’s syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/diagnosis-treatment/drc-20377259

  During a lumbar puncture, also known as a spinal tap, you typically lie on your side with your knees drawn up to your chest. Then a needle is inserted into the spinal canal in your lower back to collect cerebrospinal fluid for testing. […] There’s no specific test to diagnose Reye’s syndrome. Screening usually begins with blood and urine tests. It also may include testing for fatty acid oxidation disorders and other disorders. […] A spinal tap can help identify or rule out other diseases with similar symptoms. A spinal tap can reveal an infection of the lining that surrounds the brain and spinal cord, known as meningitis. Or it can help diagnose swelling or an infection of the brain, called encephalitis. […] A liver biopsy can help identify or rule out conditions that may be affecting the liver. In people with Reye’s syndrome, a liver biopsy can show a buildup of fats in liver cells.

• #1 Reye Syndrome Workup: Approach Considerations, Laboratory Studies, Invasive Procedures

  https://emedicine.medscape.com/article/803683-workup

  Workup to exclude inborn errors of metabolism (IEMs) must be performed and should include evaluation for defects of fatty-acid oxidation, amino and organic acidurias, urea-cycle defects, and disorders of carbohydrate metabolism. Various invasive procedures may be indicated. Computed tomography (CT) of the head may reveal cerebral edema, but the results are usually normal. Electroencephalography (EEG) may reveal slow-wave activity in the early stages and flattened waves in advanced stages. MRI characteristics of Reye syndrome are symmetric thalamic, white matter and basal ganglia lesions, in children with recent history of salycilates or immunosuppressive drugs intake. […] An ammonia level as high as 1.5 times normal 24-48 hours after the onset of mental status changes is the most frequent laboratory abnormality. Ammonia tends to peak 56-60 hours after the onset of symptoms. The ammonia level may return to normal in stages 4 and 5.

• #1 Reye Syndrome Workup: Approach Considerations, Laboratory Studies, Invasive Procedures

  https://emedicine.medscape.com/article/803683-workup

  Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increase to 3 times normal but may return to normal by stages 4 or 5. Bilirubin levels are higher than 2 mg/dL (but usually lower than 3 mg/dL) in 10-15% of patients. If the direct bilirubin level is more than 15% of total or if the total bilirubin level exceeds 3 mg/dL, consider other diagnoses. […] Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are prolonged more than 1.5-fold in more than 50% of patients. Levels of factors I (fibrinogen), II, VII, IX, and X may be low because of the disruption of synthetic activities in the liver. […] CSF WBC count, by disease definition, does not exceed 8 cells/L. Opening pressure is usually normal but may be elevated, particularly in stages 3-5. […] CT may reveal diffuse cerebral edema but may be normal. […] In early stages EEG may reveal slow wave activity, in later stages, flattened waves. […] Perilobular microvacuolar fatty infiltration of hepatocytes is a characteristic finding.

• #1 Reye’s Syndrome Nursing Care Planning and Management

  https://nurseslabs.com/reyes-syndrome/

  Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are prolonged more than 1.5-fold in more than 50% of patients. […] Glucose, while usually normal, may be low, particularly during stage 5 and in children younger than 1 year. […] If the patient is hemodynamically stable and shows no signs of increased intracranial pressure (ICP); opening pressure may or may not be increased; the white blood cell (WBC) count in the cerebrospinal fluid (CSF) is 8/L or fewer.

• #1 Diagnosis of Reye’s Syndrome

  https://www.medindia.net/health/conditions/reyes-syndrome-diagnosis.htm

  Diagnosis of Reyes syndrome follows the elicitation of a proper medical history and detailed physical examination. A number of blood tests (mostly to assess the function of liver) are ordered. […] Ammonia level as high as 1.5 times normal 24-48 hours after the onset of mental status changes is the commonest laboratory irregularity in Reyes syndrome. […] Transaminases levels: The level of liver enzymes ALT (SGPT) and AST(SGOT) increase. […] Bilirubin levels. […] Lactic dehydrogenase (LDH) level: may be high or low. […] Prothrombin time (PT) and activated partial thromboplastin time (aPTT): are prolonged. […] Lipase and amylase: are elevated. […] Serum bicarbonate: may be increased due to vomiting. […] BUN and creatinine: elevated. […] Glucose: level may be low (hypoglycaemia) especially in children younger than 1 year.

• #1 Reye’s syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/diagnosis-treatment/drc-20377259

  A head CT scan or MRI scan can help identify or rule out other causes of behavior changes or decreased alertness. These tests may show swelling in the brain, which may be caused by Reye’s syndrome. […] Reye’s syndrome is often diagnosed in an emergency situation. This is because of the serious symptoms caused by Reye’s syndrome, including seizures or loss of consciousness. Sometimes early symptoms may prompt an appointment with a healthcare professional. […] The neurologist is likely to ask about your child’s symptoms and history of viral illnesses. The neurologist may do a medical exam and schedule tests to gather information about your child’s condition. Tests also may rule out other diseases, such as meningitis or encephalitis.

• #1 Reye Syndrome – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/miscellaneous-disorders-in-infants-and-children/reye-syndrome

  Reye syndrome is a rare form of acute encephalopathy and fatty infiltration of the liver that occurs almost exclusively in children 18 years old. […] Diagnosis is clinical. […] Reye syndrome should be suspected in any child exhibiting the acute onset of an encephalopathy (without known heavy metal or toxin exposure) and pernicious vomiting associated with hepatic dysfunction. […] Liver biopsy provides the definitive diagnosis, showing microvesicular, fatty changes, and is especially useful in sporadic cases and in children 2 years. […] The diagnosis may also be made when the typical clinical findings and history are associated with the following laboratory findings: increased liver transaminases (aspartate aminotransferase, alanine aminotransferase 3 times normal), normal bilirubin, increased blood ammonia level, and prolonged prothrombin time. […] Diagnosis is by exclusion of similarly manifesting infectious, toxic, and metabolic disorders; liver biopsy may help confirm it.

• #1 Reye Syndrome Differential Diagnoses

  https://emedicine.medscape.com/article/803683-differential

  The differential diagnosis includes conditions that can cause vomiting and altered level of consciousness. The distinction between true Reye syndrome and Reye-like syndrome is often not readily established. […] Conditions that may mimic Reye syndrome include inborn errors of metabolism (IEMs), other hepatic illnesses, neuromuscular diseases, meningitis, encephalitis, obtundation due to intussusception, adverse drug reactions, and toxic exposures to chemicals and plants that cause hepatocellular damage and encephalopathy. […] Factors that increase concern for an IEM include the following: No viral prodrome, No exposure to aspirin or toxin with association to Reye syndrome, Patients younger than 3 years (in particular, those younger than 1 year), Patient or family history of Reye syndromelike illness, Rhabdomyolysis, Preexisting failure to thrive, Baseline neurologic abnormalities, Liver dysfunction or elevated ammonia level, particularly if elevated for longer than 1 week with or without waxing and waning. […] The differential diagnosis includes conditions that can cause vomiting and altered level of consciousness. The distinction between true Reye syndrome and Reye-like syndrome is often unclear.

• #1 Reye’s Syndrome: Symptoms, Causes, Treatment & Outlook

  https://my.clevelandclinic.org/health/diseases/6088-reyes-syndrome

  Reyes syndrome shares similar symptoms as many other conditions, and a misdiagnosis is possible but not common. Misdiagnosis might include: Encephalitis. Meningitis. Diabetes. Drug overdose. Poisoning. Sudden infant death syndrome. Mental illness. […] Treatment for Reyes syndrome focuses on protecting your child’s brain by reducing swelling, reversing liver damage and metabolic injury (lack of oxygen in their blood) and preventing lung complications. […] If your child receives a Reyes syndrome diagnosis, your healthcare provider will admit them into the intensive care unit immediately to receive treatment. […] Your child’s prognosis depends on the severity of their diagnosis, specifically the amount of swelling of their brain and how much ammonia is in your child’s blood. […] If the condition receives treatment early after a diagnosis, the prognosis is excellent.

• #1 Reye’s Syndrome: Symptoms, Causes, Treatment & Outlook

  https://my.clevelandclinic.org/health/diseases/6088-reyes-syndrome

  Reyes syndrome is a rare condition that happens in children after a viral infection or illness, especially if they took aspirin (salicylate) to treat their symptoms. […] Symptoms can be life-threatening if not treated early. […] Healthcare providers might suspect Reyes syndrome after detecting a viral illness followed by observing symptoms of Reyes syndrome, like vomiting and changes to your child’s behavior, including becoming easily agitated, confused or disoriented. Diagnostic tests rule out other conditions that have similar symptoms. […] Your child’s Reyes syndrome diagnosis will have a severity level marked by a Roman numeral with I (one) being the least severe and V (five) being the most severe. […] Your healthcare provider will offer several tests to confirm your child’s diagnosis. Tests could include: Laboratory tests to check ammonia levels in their blood or a buildup of toxins in their urine. Imaging tests like an MRI or CT scan to view their brain. Liver biopsy. Spinal tap to test cerebrospinal fluid.

• #1 Signs and symptoms – Reye’s syndrome

  https://reyessyndrome.rcpch.ac.uk/about-reyes-syndrome/signs-symptoms/

  Reyes syndrome should be suspected if a child displays all or part of this pattern of symptoms a few days after the onset of a viral infection such as flu or chickenpox. […] Reye’s syndrome can successfully be managed with a good outcome if diagnosed early and meticulously treated. […] Statistics indicate a better chance of survival when Reyes syndrome is diagnosed and treated in its earliest stages. The later the diagnosis, the more advanced the coma, and the chances of survival and full recovery are greatly reduced.

• #1 Reye’s Syndrome: Symptoms, Causes, Treatment & Outlook

  https://my.clevelandclinic.org/health/diseases/6088-reyes-syndrome

  The fatality rate for children diagnosed with Reyes syndrome is 21% on average. […] Early detection and treatment significantly improves the rate of survival. […] There’s no cure for Reyes syndrome. Depending on their diagnosis, many children make a full recovery. Treatment reduces symptoms and aims to prevent long-term complications or death. […] If your child experiences any symptoms of Reyes syndrome after a viral illness or infection or if your child took aspirin (salicylate) that wasn’t under your healthcare provider’s direction, see your healthcare provider immediately.

• #1 Reye’s syndrome in adults. Diagnostic considerations – PubMed

  https://pubmed.ncbi.nlm.nih.gov/3800531/

  Reye’s syndrome was diagnosed in seven 18- to 46-year-old adults. The diagnostic criteria were as follows: viral prodrome followed by vomiting and encephalopathy without focal neurological signs, normal cerebrospinal fluid values, increased levels of serum aminotransferases (transaminase), prolonged prothrombin time, elevated blood ammonia levels, and characteristic microvesicular fatty liver and mitochondrial changes. […] The diagnosis of RS was entertained in 22 but confirmed in only seven patients. […] In adults, RS is more difficult to diagnose and should be suspected more frequently in patients with unexplained altered behavior following a viral illness and vomiting. […] Liver biopsy can be performed safely and is usually mandatory in adults. Patients with RS diagnosed during stage I or II coma and treated experienced an uneventful recovery.

• #1 Reye Syndrome — United States, 1985

  https://www.cdc.gov/mmwr/preview/mmwrhtml/00000678.htm

  For 84 (92%) of the patients, a prodromal illness occurring within 2 weeks before the onset of vomiting or neurologic symptoms of RS was reported. […] At a National Institutes of Health Consensus Development Conference on the Diagnosis and Treatment of Reye Syndrome, it was recommended that, although RS diagnosis can be made in most patients without a liver biopsy, biopsy should be considered in very young children. […] It may be particularly difficult to distinguish RS from anoxic encephalopathy and inborn errors of metabolism in these children. […] Thus, before the diagnosis is established, the possibility of other more reasonable explanations for the cerebral and hepatic abnormalities should be explored, particularly in infants and young children. Histochemical staining and electron-microscopic examination of the liver, as well as a serum amino-acid profile, may help increase the specificity of diagnosis.

• #1 Is Reye’s syndrome still a valid diagnosis?

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712014000200010

  Reye’s syndrome is characterised by acute non-inflammatory encephalopathy and fatty degeneration of the liver. […] A diagnosis of Reye’s syndrome includes a review of the available history as well as laboratory investigations. The electron microscopic features of the liver tissue have always been regarded as pathognomonic in diagnosing Reye’s syndrome. […] The association of Reye’s syndrome complicated by pancreatitis is well documented. […] Is Reyes syndrome then still a valid diagnosis? Even among experts, different opinions remain. The purpose of this article is to serve as a reminder of what is regarded to be a very old diagnosis, to create awareness of the complications following aspirin use and to remember to consider pancreatitis in children who present with Reye-like symptoms.

• #1 Reye’s syndrome: Symptoms, causes, treatment, and more

  https://www.medicalnewstoday.com/articles/317960

  Reyes syndrome is considered a diagnosis of exclusion, meaning that all other possible causes have been excluded before it is decided that a person has Reyes syndrome. […] A Reyes syndrome diagnosis will be immediately treated in an ICU to protect the brain. […] Early detection and treatment is key to a full recovery, with later diagnosis sometimes leading to permanent brain damage and disability. […] For these reasons, it is essential to seek immediate medical attention whenever someone suspects Reyes syndrome.

• #1 Reye’s Syndrome — Pediatric EM Morsels

  https://pedemmorsels.com/reyes-syndrome/

  Reyes Syndrome was first describe in 1963 (by, you guessed it, Reye et al.). [Reye, 1963] […] Currently it is rare, but can still be seen. [Noor, 2018] […] An association (although not clear causality) is described between recent viral illness and aspirin therapy. […] Reyes Syndrome rates declined after warnings to avoid aspirin therapy in children. [CDC.gov] […] Currently, because Reyes Syndrome is rarely encountered, patients presenting with findings concerning for Reyes Syndrome should have other conditions ruled out. [Gosalakkal, 2008]

• #2 Reye’s Syndrome | MedlinePlus

  https://medlineplus.gov/reyesyndrome.html

  Reye syndrome can lead to a coma and brain death, so quick diagnosis and treatment are critical. […] If these symptoms occur soon after a viral illness, seek medical attention immediately. […] There is no cure.

• #2 Reye’s syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1027

  Reye syndrome is defined as acute encephalopathy with hepatic dysfunction stemming from mitochondrial damage. […] Laboratory findings include elevated ammonia, ALT/AST, and prolonged PT, without an increase in bilirubin. […] Reye’s syndrome is an illness that meets all of the following criteria: an acute, non-inflammatory encephalopathy with either sterile CSF containing 9 WBC/mL or cerebral oedema without inflammatory cell infiltrate; hepatic dysfunction documented by either a threefold elevation of serum transaminases and/or serum ammonia, or liver biopsy demonstrating fatty infiltration; there is no other diagnosis to account for the cerebral and hepatic derangement. […] Key diagnostic factors include presence of risk factors, vomiting, and altered mental status. […] Other diagnostic factors include hyperventilation, hepatomegaly, abnormal pupillary response, hyper-reflexia/areflexia, diminished pain response, seizures, and absence of, or minimal, jaundice and scleral icterus. […] 1st investigations to order include serum electrolytes, serum glucose, LFTs, serum ammonia, PT/PTT, urine/serum toxicology, urinalysis, and blood gas. […] Investigations to consider include cranial CT, lumbar puncture with cerebrospinal fluid analysis, EEG, liver biopsy, and metabolic testing.

• #2 Reye’s Syndrome: Symptoms, Causes, Treatment & Outlook

  https://my.clevelandclinic.org/health/diseases/6088-reyes-syndrome

  Reyes syndrome is a rare condition that happens in children after a viral infection or illness, especially if they took aspirin (salicylate) to treat their symptoms. […] Symptoms can be life-threatening if not treated early. […] Healthcare providers might suspect Reyes syndrome after detecting a viral illness followed by observing symptoms of Reyes syndrome, like vomiting and changes to your child’s behavior, including becoming easily agitated, confused or disoriented. Diagnostic tests rule out other conditions that have similar symptoms. […] Your child’s Reyes syndrome diagnosis will have a severity level marked by a Roman numeral with I (one) being the least severe and V (five) being the most severe. […] Your healthcare provider will offer several tests to confirm your child’s diagnosis. Tests could include: Laboratory tests to check ammonia levels in their blood or a buildup of toxins in their urine. Imaging tests like an MRI or CT scan to view their brain. Liver biopsy. Spinal tap to test cerebrospinal fluid.

• #2 Reye Syndrome Workup: Approach Considerations, Laboratory Studies, Invasive Procedures

  https://emedicine.medscape.com/article/803683-workup

  Workup to exclude inborn errors of metabolism (IEMs) must be performed and should include evaluation for defects of fatty-acid oxidation, amino and organic acidurias, urea-cycle defects, and disorders of carbohydrate metabolism. Various invasive procedures may be indicated. Computed tomography (CT) of the head may reveal cerebral edema, but the results are usually normal. Electroencephalography (EEG) may reveal slow-wave activity in the early stages and flattened waves in advanced stages. MRI characteristics of Reye syndrome are symmetric thalamic, white matter and basal ganglia lesions, in children with recent history of salycilates or immunosuppressive drugs intake. […] An ammonia level as high as 1.5 times normal 24-48 hours after the onset of mental status changes is the most frequent laboratory abnormality. Ammonia tends to peak 56-60 hours after the onset of symptoms. The ammonia level may return to normal in stages 4 and 5.

• #2 Reye’s Syndrome Nursing Care Planning and Management

  https://nurseslabs.com/reyes-syndrome/

  Reye syndrome can lead to rapid and severe neurological deterioration, making prompt recognition, close monitoring, and supportive care crucial in preventing complications. […] Workup to exclude inborn errors of metabolism (IEMs) must be performed and should include evaluation for defects of fatty-acid oxidation, amino and organic acidurias, urea-cycle defects, and disorders of carbohydrate metabolism. […] An ammonia level as high as 1.5 times normal 24-48 hours after the onset of mental status changes is the most frequent laboratory abnormality. […] Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increase to 3 times normal but may return to normal by stages 4 or 5. […] Bilirubin levels are higher than 2 mg/dL (but usually lower than 3 mg/dL) in 10-15% of patients; if the direct bilirubin level is more than 15% of total or if the total bilirubin level exceeds 3 mg/dL, consider other diagnoses.

• #2 Reye’s syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/diagnosis-treatment/drc-20377259

  A head CT scan or MRI scan can help identify or rule out other causes of behavior changes or decreased alertness. These tests may show swelling in the brain, which may be caused by Reye’s syndrome. […] Reye’s syndrome is often diagnosed in an emergency situation. This is because of the serious symptoms caused by Reye’s syndrome, including seizures or loss of consciousness. Sometimes early symptoms may prompt an appointment with a healthcare professional. […] The neurologist is likely to ask about your child’s symptoms and history of viral illnesses. The neurologist may do a medical exam and schedule tests to gather information about your child’s condition. Tests also may rule out other diseases, such as meningitis or encephalitis.

• #2 Reye Syndrome in Children – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=reye-syndrome-in-children-90-P02620

  How is Reye syndrome diagnosed in a child? The healthcare provider will ask about your childs symptoms and health history. He or she will ask about any recent viral illness, and if your child has taken aspirin or medicine that contains aspirin. He or she will give your child a physical exam. Your child may also have tests such as: […] Blood tests. These look at liver function and other signs of problems in the body. […] Urine and stool tests. Urine and stool may be tested for signs of illness. […] Liver biopsy. A small sample of tissue is removed from the liver and studied to help diagnose different illnesses. Certain changes on the liver biopsy can help diagnose Reye syndrome. […] Electroencephalogram (EEG). This test records the brain’s constant electrical activity, using electrodes placed on the scalp.

• #2 Reye Syndrome Workup: Approach Considerations, Laboratory Studies, Invasive Procedures

  https://emedicine.medscape.com/article/803683-workup

  Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increase to 3 times normal but may return to normal by stages 4 or 5. Bilirubin levels are higher than 2 mg/dL (but usually lower than 3 mg/dL) in 10-15% of patients. If the direct bilirubin level is more than 15% of total or if the total bilirubin level exceeds 3 mg/dL, consider other diagnoses. […] Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are prolonged more than 1.5-fold in more than 50% of patients. Levels of factors I (fibrinogen), II, VII, IX, and X may be low because of the disruption of synthetic activities in the liver. […] CSF WBC count, by disease definition, does not exceed 8 cells/L. Opening pressure is usually normal but may be elevated, particularly in stages 3-5. […] CT may reveal diffuse cerebral edema but may be normal. […] In early stages EEG may reveal slow wave activity, in later stages, flattened waves. […] Perilobular microvacuolar fatty infiltration of hepatocytes is a characteristic finding.

• #2 Reye’s syndrome in adults. Diagnostic considerations – PubMed

  https://pubmed.ncbi.nlm.nih.gov/3800531/

  Reye’s syndrome was diagnosed in seven 18- to 46-year-old adults. The diagnostic criteria were as follows: viral prodrome followed by vomiting and encephalopathy without focal neurological signs, normal cerebrospinal fluid values, increased levels of serum aminotransferases (transaminase), prolonged prothrombin time, elevated blood ammonia levels, and characteristic microvesicular fatty liver and mitochondrial changes. […] The diagnosis of RS was entertained in 22 but confirmed in only seven patients. […] In adults, RS is more difficult to diagnose and should be suspected more frequently in patients with unexplained altered behavior following a viral illness and vomiting. […] Liver biopsy can be performed safely and is usually mandatory in adults. Patients with RS diagnosed during stage I or II coma and treated experienced an uneventful recovery.

• #2 Reye Syndrome in Children – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=reye-syndrome-in-children-90-P02620

  Spinal tap (lumbar puncture). The healthcare provider puts a needle into your child’s lower back, into the spinal canal. This is the area around the spinal cord. The provider measures the pressure in the spinal canal and brain. He or she takes a small sample of cerebrospinal fluid (CSF). CSF is the fluid that surrounds the brain and spinal cord. The CSF is sent for testing to see if there is an infection. […] Intracranial pressure monitoring (ICP). This test measures the pressure inside of the child’s skull. […] MRI. This test uses a large magnet, radio signals, and a computer to make detailed images of the inside of the body.

• #2 Reye’s Syndrome: Symptoms, Causes, Treatment & Outlook

  https://my.clevelandclinic.org/health/diseases/6088-reyes-syndrome

  Reyes syndrome shares similar symptoms as many other conditions, and a misdiagnosis is possible but not common. Misdiagnosis might include: Encephalitis. Meningitis. Diabetes. Drug overdose. Poisoning. Sudden infant death syndrome. Mental illness. […] Treatment for Reyes syndrome focuses on protecting your child’s brain by reducing swelling, reversing liver damage and metabolic injury (lack of oxygen in their blood) and preventing lung complications. […] If your child receives a Reyes syndrome diagnosis, your healthcare provider will admit them into the intensive care unit immediately to receive treatment. […] Your child’s prognosis depends on the severity of their diagnosis, specifically the amount of swelling of their brain and how much ammonia is in your child’s blood. […] If the condition receives treatment early after a diagnosis, the prognosis is excellent.

• #2 Reye’s Syndrome: A Rare But Serious Pediatric Condition

  https://www.uspharmacist.com/article/reyes-syndrome-a-rare-but-serious-pediatric-condition

  Because no test is specific for Reyes syndrome, it is a diagnosis of exclusion. A high index of suspicion must be present in a patient with vomiting and mental status changes. […] Diseases and conditions that resemble Reyes syndrome must be ruled out. These conditions include metabolic disorders such as defects in fatty acid oxidation (including acyl-CoA dehydrogenase deficiencies), disorders of oxidative phosphorylation, urea-cycle defects, disorders of carbohydrate metabolism, other metabolic disorders and errors of inborn metabolism, CNS infection or meningitis, and drug or toxic ingestion. Disorders causing presentation with acute liver failure should also be ruled out.

• #2 Related conditions – Reye’s Syndrome – Causes, Symptoms, Treatment, Diagnosis – MedBroadcast.com

  https://medbroadcast.com/channel/baby-health/related-conditions/reyes-syndrome

  Reye’s syndrome usually occurs during or after a viral infection involving the airways. […] Early diagnosis is crucial. A doctor who suspects Reye’s will look for elevated ammonia levels in the blood, and will perform liver function tests. Results usually take 2 to 3 hours to arrive. A liver biopsy may be performed, and may be especially helpful in young children under 2 years old. An MRI or CT scan of the head will likely be done for a child with altered mental status. […] A spinal tap (lumbar puncture) test may be performed. This won’t detect Reye’s, but it’s important to eliminate the possibility of meningitis or encephalitis, which are direct infections in or around the brain that can also be caused by viruses and that are far more common.

• #2 Reye Syndrome Differential Diagnoses

  https://emedicine.medscape.com/article/803683-differential

  The differential diagnosis includes conditions that can cause vomiting and altered level of consciousness. The distinction between true Reye syndrome and Reye-like syndrome is often not readily established. […] Conditions that may mimic Reye syndrome include inborn errors of metabolism (IEMs), other hepatic illnesses, neuromuscular diseases, meningitis, encephalitis, obtundation due to intussusception, adverse drug reactions, and toxic exposures to chemicals and plants that cause hepatocellular damage and encephalopathy. […] Factors that increase concern for an IEM include the following: No viral prodrome, No exposure to aspirin or toxin with association to Reye syndrome, Patients younger than 3 years (in particular, those younger than 1 year), Patient or family history of Reye syndromelike illness, Rhabdomyolysis, Preexisting failure to thrive, Baseline neurologic abnormalities, Liver dysfunction or elevated ammonia level, particularly if elevated for longer than 1 week with or without waxing and waning. […] The differential diagnosis includes conditions that can cause vomiting and altered level of consciousness. The distinction between true Reye syndrome and Reye-like syndrome is often unclear.

• #2 Reye Syndrome – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/miscellaneous-disorders-in-infants-and-young-children/reye-syndrome

  The diagnosis is based on sudden changes in the child’s mental condition and on the results of blood tests and a liver biopsy. […] To confirm the diagnosis of Reye syndrome and rule out other diseases, such as certain hereditary metabolic disorders, doctors do blood tests and often remove a piece of liver tissue using a small needle (liver biopsy). […] Doctors suspect Reye syndrome in children who suddenly develop changes in mental condition and vomiting. […] Once the diagnosis is confirmed, the level of severity is staged from I (lowest) to V (highest) based on the symptoms and test results.

• #2 Reye s Syndrome

  https://www.brainfacts.org/diseases-and-disorders/neurological-disorders-az/diseases-a-to-z-from-ninds/reye-s-syndrome

  Reye’s syndrome (RS) is often misdiagnosed as encephalitis, meningitis, diabetes, drug overdose, poisoning, sudden infant death syndrome, or psychiatric illness. […] If these symptoms are present during or soon after a viral illness, medical attention should be sought immediately. […] Successful management, which depends on early diagnosis, is primarily aimed at protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest. […] Statistics indicate that when RS is diagnosed and treated in its early stages, chances of recovery are excellent. When diagnosis and treatment are delayed, the chances for successful recovery and survival are severely reduced.

• #2 Reye Syndrome in Children | UMass Memorial Health

  https://www.ummhealth.org/health-library/reye-syndrome-in-children

  Reye syndrome is a rare but very serious illness that causes brain swelling and liver damage. […] Symptoms occur very suddenly. If Reye syndrome is diagnosed and treated early, many children recover fully. But if not treated quickly, Reye syndrome can cause a child to go into a coma, lead to brain damage, or cause death. […] The healthcare provider will ask about your child’s symptoms and health history. The provider will also ask about any recent viral illness, and if your child has taken aspirin or medicine that contains aspirin. The provider will give your child a physical exam. Your child may also have tests, such as: […] The key is to treat the illness as early as possible. This is a serious illness that can quickly get worse. […] If not treated quickly, Reye syndrome can cause a child to go into a coma, lead to brain damage, or cause death. […] If your child shows any symptoms of Reye syndrome during or right after a viral illness, get medical care right away.

• #2 Reye’s Syndrome: Causes, Risks & Treatment

  https://liverfoundation.org/liver-diseases/pediatric-liver-information-center/pediatric-liver-disease/reyes-syndrome/

  Reye syndrome is a rare illness that affects all bodily organs but is most harmful to the brain and the liver. It occurs primarily among children who are recovering from a viral infection, such as chicken pox or the flu. […] If your child becomes sick with a possible case of Reye syndrome, doctors will want blood tests to evaluate his or her liver function. They may also evaluate other possible causes of liver problems and make sure your child does not have one of the rare inherited disorders that mimic Reye syndrome. In addition to blood and urine tests, diagnostic procedures may include spinal taps or liver biopsy. […] There is no cure for Reye syndrome. Successful management, which relies on early diagnosis, is aimed primarily at protecting the brain from irreversible damage by reducing brain swelling, preventing complications in the lungs, and anticipating cardiac arrest.

• #2 What is Reyes Syndrome? | Reyessyndrome

  https://www.reyes-syndrome.org/blank-1

  Reye’s Syndrome should be suspected in a person if this pattern of symptoms appear during, or most commonly, after a viral illness. […] Physicians and medical staff in emergency rooms who have not had experience in treating Reye’s Syndrome may misdiagnose the disease. […] For Early Diagnosis: Vomiting, think Reye’s […] Emergency SGOT-SGPT (SAT-ACT) […] Elevated blood NH3 […] Hypoglycemia and hepatomegaly may be present. […] Reye’s is often mistaken for the diagnosis listed above, so encourage your doctor to look twice and to consider ruling out Reye’s!

• #2 Reye syndrome: Causes, Symptoms, Diagnosis, And Treatment

  https://www.netmeds.com/health-library/post/reye-syndrome-causes-symptoms-diagnosis-and-treatment?srsltid=AfmBOop2YvWwdHn8KjeFKhCD3VuSE15NBjKsf0PM6v0zd4qmmlcU990q

  To save the life of the child diagnosed with this serious health problem, an early diagnosis, and timely treatment of Reye’s syndrome are extremely important. […] If the infant or child displays any above-mentioned symptoms more so, after being infected with chicken pox or flu vomits repeatedly, is sluggish, or has abrupt behavior changes, the action should be prompt. […] The child should be immediately put on an initial treatment plan. While there is no set or specific treatment for Reye’s syndrome, the doctors focus on reducing symptoms and preventing complications. […] Lack of proper and timely diagnosis can cause serious complications arising from this disease. Generally, if the ailment is identified on time, most children and teenagers who have Reye’s syndrome will survive. […] However, if it is not diagnosed in time, varying degrees of permanent damage to the brain is possible.

• #3 Reye Syndrome in Children

  https://www.nationwidechildrens.org/conditions/health-library/reye-syndrome-in-children

  Reye syndrome is a rare but very serious illness that causes brain swelling and liver damage. […] Symptoms occur very suddenly. If Reye syndrome is diagnosed and treated early, many children recover fully. But if not treated quickly, Reye syndrome can cause a child to go into a coma, lead to brain damage, or cause death. […] The healthcare provider will ask about your child’s symptoms and health history. The provider will also ask about any recent viral illness, and if your child has taken aspirin or medicine that contains aspirin. […] The provider will give your child a physical exam. Your child may also have tests, such as: […] Certain changes on the liver biopsy can help diagnose Reye syndrome. […] If diagnosed and treated early, many children recover fully. But if not treated quickly, Reye syndrome can cause a child to go into a coma, lead to brain damage, or cause death.

• #3 Reye syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1027

  Reye syndrome is defined as acute encephalopathy with hepatic dysfunction stemming from mitochondrial damage. […] Laboratory findings include elevated ammonia, ALT/AST, and prolonged PT, without an increase in bilirubin. […] Reye syndrome is an illness that meets all the following criteria: an acute, noninflammatory encephalopathy with either sterile CSF containing 9 WBC/mL or cerebral edema without inflammatory cell infiltrate; hepatic dysfunction documented by either a threefold elevation of serum transaminases and/or serum ammonia, or liver biopsy demonstrating fatty infiltration; there is no other diagnosis to account for the cerebral and hepatic derangement. […] Key diagnostic factors include vomiting and altered mental status. […] Other diagnostic factors include hyperventilation, hepatomegaly, abnormal pupillary response, hyperreflexia/areflexia, diminished pain response, seizures, and absence of, or minimal, jaundice and scleral icterus. […] 1st investigations to order include serum electrolytes, serum glucose, LFTs, serum ammonia, PT/PTT, urine/serum toxicology, urinalysis, and blood gas. […] Investigations to consider include cranial CT, lumbar puncture with cerebrospinal fluid analysis, EEG, liver biopsy, and metabolic testing.

• #3 Diagnosis of Reye’s Syndrome

  https://www.medindia.net/health/conditions/reyes-syndrome-diagnosis.htm

  Diagnosis of Reyes syndrome follows the elicitation of a proper medical history and detailed physical examination. A number of blood tests (mostly to assess the function of liver) are ordered. […] Ammonia level as high as 1.5 times normal 24-48 hours after the onset of mental status changes is the commonest laboratory irregularity in Reyes syndrome. […] Transaminases levels: The level of liver enzymes ALT (SGPT) and AST(SGOT) increase. […] Bilirubin levels. […] Lactic dehydrogenase (LDH) level: may be high or low. […] Prothrombin time (PT) and activated partial thromboplastin time (aPTT): are prolonged. […] Lipase and amylase: are elevated. […] Serum bicarbonate: may be increased due to vomiting. […] BUN and creatinine: elevated. […] Glucose: level may be low (hypoglycaemia) especially in children younger than 1 year.

• #3 Reye’s syndrome | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/reyes-syndrome?content_id=CON-20377238

  Early diagnosis and treatment of Reye’s syndrome can save a child’s life. […] There’s no specific test to diagnose Reye’s syndrome. Screening usually begins with blood and urine tests. It also may include testing for fatty acid oxidation disorders and other disorders. […] A spinal tap can help identify or rule out other diseases with similar symptoms. A spinal tap can reveal an infection of the lining that surrounds the brain and spinal cord, known as meningitis. […] A liver biopsy can help identify or rule out conditions that may be affecting the liver. In people with Reye’s syndrome, a liver biopsy can show a buildup of fats in liver cells. […] A head CT scan or MRI scan can help identify or rule out other causes of behavior changes or decreased alertness. These tests may show swelling in the brain, which may be caused by Reye’s syndrome.

• #3 Reye Syndrome – What You Need to Know

  https://www.drugs.com/cg/reye-syndrome.html

  How is Reye syndrome diagnosed? […] Your child’s healthcare provider will examine your child. Tell the provider if your child has recently had aspirin, over-the-counter medicine, herbal medicine, or vitamins. Also tell the provider if your child has recently been sick. Your child may need any of the following: […] Blood tests check your child’s liver function and electrolyte levels. Examples of electrolytes include potassium, calcium, and sodium. […] A CT or MRI may show swelling in your child’s brain. Your child may be given contrast liquid to help his or her brain tissue show up better in the pictures. Tell your child’s provider if he or she has ever had an allergic reaction to contrast liquid. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell your child’s provider if he or she has any metal in or on his or her body. […] A lumbar puncture, or spinal tap, may show infection and inflammation in the fluid that surrounds your child’s brain and spinal cord. A needle is inserted into your child’s spine and a sample of fluid is taken. The sample is sent to a lab and tested.

• #3 Reye’s syndrome symptoms, diagnosis, treatment, and prevention

  https://www.singlecare.com/blog/reyes-syndrome/

  A number of other disorders can cause symptoms that are similar to Reyes syndrome, so part of the diagnosis will consist of ruling out conditions like fatty-acid oxidation disorders and other liver function issues, inborn errors of metabolism and other metabolic disorders, substance use, ingestion, or exposure to toxins, central nervous system infections such as encephalitis (inflammation of the brain) and meningitis (inflammation of the protective membranes surrounding the brain and spinal cord), psychiatric illness. […] In some cases, a spinal tap may be done to detect increased pressure in the bodys cerebrospinal fluid (CSF). In this procedure, also called a lumbar puncture, a needle is inserted through the lower back into a space alongside the spinal column, and a small amount of CSF is removed for testing. Increased intracranial pressure can also sometimes be detected by magnetic resonance imaging (MRI) or a computerized tomography (CT) scan, and doctors may order one of these tests in evaluating the cause.

• #3 Reye Syndrome – Children’s Health Issues – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/children-s-health-issues/neurologic-disorders-in-children/reye-syndrome

  The diagnosis is based on sudden changes in the child’s mental condition and on the results of blood tests and a liver biopsy. […] To confirm the diagnosis of Reye syndrome and rule out other diseases, such as certain hereditary metabolic disorders, doctors do blood tests and often remove a piece of liver tissue using a small needle (liver biopsy). […] Doctors suspect Reye syndrome in children who suddenly develop changes in mental condition and vomiting. […] Once the diagnosis is confirmed, the level of severity is staged from 1 (lowest) to 5 (highest) based on the symptoms.

• #3 Reye s Syndrome

  https://www.brainfacts.org/diseases-and-disorders/neurological-disorders-az/diseases-a-to-z-from-ninds/reye-s-syndrome

  Reye’s syndrome (RS) is often misdiagnosed as encephalitis, meningitis, diabetes, drug overdose, poisoning, sudden infant death syndrome, or psychiatric illness. […] If these symptoms are present during or soon after a viral illness, medical attention should be sought immediately. […] Successful management, which depends on early diagnosis, is primarily aimed at protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest. […] Statistics indicate that when RS is diagnosed and treated in its early stages, chances of recovery are excellent. When diagnosis and treatment are delayed, the chances for successful recovery and survival are severely reduced.

• #4 Signs and symptoms – Reye’s syndrome

  https://reyessyndrome.rcpch.ac.uk/about-reyes-syndrome/signs-symptoms/

  Reyes syndrome should be suspected if a child displays all or part of this pattern of symptoms a few days after the onset of a viral infection such as flu or chickenpox. […] Reye’s syndrome can successfully be managed with a good outcome if diagnosed early and meticulously treated. […] Statistics indicate a better chance of survival when Reyes syndrome is diagnosed and treated in its earliest stages. The later the diagnosis, the more advanced the coma, and the chances of survival and full recovery are greatly reduced.

• #4 Mayo Clinic Health Library – Reye’s syndrome | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20377238

  Early diagnosis and treatment of Reye’s syndrome can save a child’s life. […] There’s no specific test to diagnose Reye’s syndrome. Screening usually begins with blood and urine tests. It also may include testing for fatty acid oxidation disorders and other disorders. […] A spinal tap can help identify or rule out other diseases with similar symptoms. […] A liver biopsy can help identify or rule out conditions that may be affecting the liver. […] A head CT scan or MRI scan can help identify or rule out other causes of behavior changes or decreased alertness.

• #4 Reye Syndrome in Children

  https://healthlibrary.umcno.org/Wellness/Stress/90,P02620

  Blood tests. These look at liver function and other signs of problems in the body. […] Urine and stool tests. Urine and stool may be tested for signs of illness. […] Liver biopsy. A small sample of tissue is removed from the liver and studied to help diagnose different illnesses. Certain changes on the liver biopsy can help diagnose Reye syndrome. […] Electroencephalogram (EEG). This test records the brain’s constant electrical activity, using electrodes placed on the scalp. […] Spinal tap (lumbar puncture). The healthcare provider puts a needle into your child’s lower back, into the spinal canal. This is the area around the spinal cord. The provider measures the pressure in the spinal canal and brain. The provider takes a small sample of cerebrospinal fluid (CSF). CSF is the fluid that surrounds the brain and spinal cord. The CSF is sent for testing to see if there is an infection.

• #4 Reye s Syndrome

  https://www.brainfacts.org/diseases-and-disorders/neurological-disorders-az/diseases-a-to-z-from-ninds/reye-s-syndrome

  Reye’s syndrome (RS) is often misdiagnosed as encephalitis, meningitis, diabetes, drug overdose, poisoning, sudden infant death syndrome, or psychiatric illness. […] If these symptoms are present during or soon after a viral illness, medical attention should be sought immediately. […] Successful management, which depends on early diagnosis, is primarily aimed at protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest. […] Statistics indicate that when RS is diagnosed and treated in its early stages, chances of recovery are excellent. When diagnosis and treatment are delayed, the chances for successful recovery and survival are severely reduced.

• #4 Reye Syndrome – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/miscellaneous-disorders-in-infants-and-young-children/reye-syndrome

  The diagnosis is based on sudden changes in the child’s mental condition and on the results of blood tests and a liver biopsy. […] To confirm the diagnosis of Reye syndrome and rule out other diseases, such as certain hereditary metabolic disorders, doctors do blood tests and often remove a piece of liver tissue using a small needle (liver biopsy). […] Doctors suspect Reye syndrome in children who suddenly develop changes in mental condition and vomiting. […] Once the diagnosis is confirmed, the level of severity is staged from I (lowest) to V (highest) based on the symptoms and test results.

• #4 Reye syndrome: Causes, Symptoms, Diagnosis, And Treatment

  https://www.netmeds.com/health-library/post/reye-syndrome-causes-symptoms-diagnosis-and-treatment?srsltid=AfmBOop2YvWwdHn8KjeFKhCD3VuSE15NBjKsf0PM6v0zd4qmmlcU990q

  To save the life of the child diagnosed with this serious health problem, an early diagnosis, and timely treatment of Reye’s syndrome are extremely important. […] If the infant or child displays any above-mentioned symptoms more so, after being infected with chicken pox or flu vomits repeatedly, is sluggish, or has abrupt behavior changes, the action should be prompt. […] The child should be immediately put on an initial treatment plan. While there is no set or specific treatment for Reye’s syndrome, the doctors focus on reducing symptoms and preventing complications. […] Lack of proper and timely diagnosis can cause serious complications arising from this disease. Generally, if the ailment is identified on time, most children and teenagers who have Reye’s syndrome will survive. […] However, if it is not diagnosed in time, varying degrees of permanent damage to the brain is possible.

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