Fortunately, most children whom doctors evaluate for possible signs and symptoms of Reye’s syndrome don’t have the disease. Instead, they may not have fully recovered from a flu-like illness, or they may be dealing with complications of dehydration. Children who receive a diagnosis of Reye’s syndrome, however, may require admission to a pediatric intensive care unit. Drug treatments may include:
- Intravenous fluids. These may include glucose to increase low blood sugar; electrolyte solutions containing sodium, potassium and chloride to correct blood chemistry values; and basic solutions to treat acidity.
- Insulin. Small amounts of insulin can increase sugar metabolism.
- Corticosteroids. A corticosteroid medication can reduce brain swelling and inflammation.
- Diuretics. A diuretic, such as mannitol, can increase fluid loss through urination and help reduce brain swelling.
Physicians may want to continuously monitor your child’s blood pressure using a thin, flexible tube (arterial catheter). An arterial catheter is threaded into an artery and is commonly used to monitor blood gases and acidity, as well as blood pressure.
If Reye’s syndrome reaches an advanced stage, treatment may include the use of a ventilator to help assist a child with breathing.
To reduce the risk of Reye’s syndrome, avoid giving aspirin or medications that contain aspirin to your child to treat viral illnesses. Other names for aspirin include:
- Acetylsalicylic acid
- Salicylic acid/Salicylate
If a child or teenager has the flu or chickenpox, use other medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) to reduce fever or relieve pain. Unless specifically advised by your child’s doctor, don’t give aspirin to anyone younger than 19. Check the label on any medication you’re going to give your child, because aspirin can show up in some unexpected places. Some products that contain aspirin include Alka-Seltzer, some Excedrin products and Pepto-Bismol. Also, check with your doctor before giving your child any alternative or folk remedies. Some of these also contain aspirin. If a full ingredient list isn’t available, don’t give the medicine to your child without checking with your doctor first.
Some children with chronic diseases, such as juvenile rheumatoid arthritis, may need treatment long term with drugs that contain aspirin. Doctors advise that these children receive the varicella (chickenpox) and influenza vaccines to reduce their risk of developing Reye’s syndrome. In fact, the varicella vaccine is now recommended for all healthy children between 12 and 15 months old. It’s also recommended that children between six and 24 months of age receive the influenza vaccine each October. Never having these two diseases helps prevent Reye’s syndrome.
- Failure to identify hypoglycemia and treat it
- Failure to recognize that progression of disease may be extremely rapid
- Overhydrating the patient with exacerbation of cerebral edema
- Failure to aggressively treat cerebral edema (the major cause of morbidity and mortality)
- Reye syndrome is now exceedingly rare.
- Evaluate patients for an IEM that mimics Reye syndrome, particularly (but not exclusively) patients younger than 3 years.
- Consider a metabolic disease (eg, amino or organic acidemia, defect in the urea cycle or fatty-acid oxidation [particularly medium-chain acyl-CoA dehydrogenase deficiency]) if the following conditions pertain:
- No viral prodrome
- No exposure to aspirin or toxin with association to Reye syndrome
- Patients younger than 3 years (especially those <1 y)
- Patient or family history of Reye syndrome–type illness
- Preexisting failure to thrive
- Baseline neurologic abnormalities
Liver dysfunction and/or elevated ammonia level, particularly if it is >1200 mcg/dL and/or if it is elevated longer than 1 week with or without waxing and waning