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Reye’s Syndrome

Reye’s Syndrome. Why not to give ASA to pediatrics. By: Adam Wilkinson. What is it?. Children’s Disease? (or is it?) Affects all organs Primarily the brain and liver. Multi Stage Illness Stage 0-6. Hx of Reye’s Syndrome. 1963; R.D.K. Reye described syndrome in Australia.

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Reye’s Syndrome

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  1. Reye’s Syndrome Why not to give ASA to pediatrics. By: Adam Wilkinson

  2. What is it? • Children’s Disease? (or is it?) • Affects all organs • Primarily the brain and liver. • Multi Stage Illness • Stage 0-6

  3. Hx of Reye’s Syndrome • 1963; R.D.K. Reye described syndrome in Australia. • Few months later G.M. Johnson described it in the US. • Similar cases described as early as 1929. • Occurrences • Peaked during 1980 • 500 Cases • >100 deaths in children • Now <0.03-1 case per 100,000 • Peds <18y/o • May be higher in regional viral epidemics • <0.1% in peds with viral illness treated with ASA.

  4. That is great but what does it do? • Acute Encephalopathy • Layman’s terms please! • Generalized brain dysfunction • Fatty tissue infiltration • Liver most prominent • Other organs also effected

  5. Ok ok, so its bad… • What causes it? • NO ONE KNOWS?!?!? • So where does ASA come in? • Increases risk by 35 fold! • 90-95% of cases in US had taken ASA during a preceding viral infection. • Other possible causes • Toxins • Inborn Error of Metabolisim • Follows Viral Illness • Usually Chicken Pox or Influenza

  6. Signs/Symptoms • Mimics viral illnesses • Hard to diagnose • Persistent/recurrent vomiting • Listlessness • Personality changes (Irritability or combative) • Disorientation or confusion • Delirium • Convulsions • Loss of consciousness

  7. Complications of Reye’s • Brain herniation • Permanent brain damage • Acute Respiratory Failure • Cardiovascular collapse • GI bleeding • Acute Renal Failure • Sepsis • Death

  8. Mortality/Morbidity • Mortality • Decreased from 80% in 1963 to 31% in 1983 • Increased in 1996 back up to 50% (Conflicting information) • Due to misdiagnosis • Death • Usually caused by ICP • Other Causes: • Myocardial Dysfunction • Cardiovascular collapse • Respiratory failure • Renal failure • GI bleeding • Status epilepticus • Sepsis

  9. Who is at risk? • Age: peak 5-14 y/o • Rarely occurs in newborns or peds >18y/o • Race: • 93% White • 12% of White pts are <1/yo • 5% African American • 67% of African American pts are <1y/o

  10. So what do I do about it? • Education: Inform parents about the risk. • Pre Hospital Treatment: • ABCs • CBG • Especially if pt <1y/o or has an AMS • Manage Hypoglycemia • Transport

  11. What can the hospital do about it? • No specific treatment exists • Monitor patient • Treat metabolic abnormalities • Prevent/control cerebral edema • Stage specific care • Cure? • No cure: Recovery is dependant on severity of brain swelling • Faster progression worse prognosis

  12. Reye’s at a glance… • Grave reaction to certain viral infections • Chicken pox • Influenza • ASA during these illnesses increases risk 35 fold. • Increased cerebral edema and fatty tissue infiltration of liver & other organs. • Treatable but can be lethal • Preventable

  13. Questions?

  14. Bibliography Beers, Mark H., Robert S. Porter, Thomas V. Jones, Justin L. Kapalan, and Michael Berkwits, eds. THE MERCK MANUAL. 18th ed. Whitehouse Station, NJ: MERCK Research Laboratories, 2006. 2401-2402. Reye's Syndrome Foundation. 27 May 2008 <http://www.reyessyndrome.org>. "Reye's Syndrome." MedicineNet.Com. 27 May 2008 <http://www.medicinenet.com/reye_syndrome/article.htm>. Venes, Donald, ed. Taber's Cyclopedic Medical Dictionary. 20th ed. Philidelphia, PA: F.a. Davis Co., 2005. 1907. Weiner, Debra L. "Pediatrics, Reye's Syndrome." EMedicine. 28 Nov. 2005. Dept. of Pediatrics, Div. of Emergency Medicine, Childrens Hospital , Boston Harvard Medical School. 27 May 2008 <http://www.emedicine.com/emerg/TOPIC399.HTM>. Woo-Ming, Michael. "Reye's Syndrome: Why You Should Never Give Aspirin to Kids." Personal MD. 02 Aug. 2000. Personalmd.Com. 27 May 2008 <www.personalmd.com/news/reyessyndrome_80200.shtml>.

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