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Reye Syndrome: Symptoms, Causes, Prevention, and Treatment

What is Reye syndrome?

Reye Syndrome can be characterised by acute non-inflammatory encephalopathy and fatty degenerative liver failure. In 1963, this disease along with its symptoms was first described in Australia by RDK Reye. For its rarity, proper knowledge about Reye Syndrome is yet limited. There are only 20 cases approx per year since 1988.

Reye Syndrome is a disorder which can lead to severe damage of liver and brain. Children and young adults are the common victims of this disease. Reports say that Reye Syndrome occurs mostly during the recovery period from a viral infection, such as flu or chicken pox. The alarming thing about this disease is that it can be misdiagnosed. It is often misdiagnosed as encephalitis, diabetes, meningitis, poisoning, drugs overdose or even psychiatric illness.

Symptoms of Reye Syndrome

The basic symptoms of Reye Syndrome typically emerge after three or five days after the viral infection. The symptoms of Reye Syndrome generally include vomiting, personality changes which can include irritability and combativeness, convulsions etc. If these symptoms emerge themselves even during the viral infection, immediate medical attention should be sought.

There are certain trends in the symptoms of Reye syndrome, the most distinguishable are:

  • Symptoms of children who are less than two years old: The initial symptoms of Reye Syndrome generally include rapidness of breathing and diarrhoea.
  • For young adults or children more than two years: For them, the early signs can include persistent vomiting or lethargy.

Additionally, the patient’s sugar level can drop drastically with the levels of ammonia and acid rise rapidly. In this syndrome, the liver can be enlarged due to excessive fatty deposits in the liver.

More symptoms include:

  • Abnormalities of behaviour, such as sudden aggressiveness or irritation which is generally unexplained.
  • Hallucinations, confusion
  • Weakened arms and legs which can be extended to even paralysis.
  • Lethargic condition
  • Sudden decreased level of consciousness
  • There can also be an extreme symptom such as coma

It is possible that the symptoms can often be confused with other diseases such as meningitis, drugs overdose, poisoning, and the delirium and irritation can also vouch for psychiatric illness. It is advisable to the family of the patient to seek medical attention as soon as the symptoms begin surfacing. If delayed Reye Syndrome can prove to be fatal and can often lead to death.

Causes of Reye Syndrome

The number of cases has been a roadblock to determine the exact reasons for Reye Syndrome. There can be several factors which can play an important role in building up Reye Syndrome.

  • Studies and reports have shown that the syndrome can be triggered when patients consume aspirin while having a viral infection.
  • Also, studies indicate that children and young adults who have fatty acid oxidation disorder, which has been yet detected, can also become victims of Reye Syndrome. Fatty acid oxidation disorder is the disease where the body is unable to break the fatty acids.
  • Over the counter medication with a composition including salicylates can also trigger the Reye Syndrome. These medications include bismuth subsalicylate and medication which has oil of wintergreen as its ingredient.

In Reye syndrome, studies have indicated that mitochondria get affected. As mitochondria are responsible for the cell’s energy and help the liver to function properly, damaged mitochondria mean the liver loses the energy supply, and it causes toxicity level to rise in the blood.

Risk factors for Reye Syndrome

  • The riskiest factor of Reye Syndrome is to consuming aspirin while having flu or chicken pox. Flu or chicken pox often have a headache as its symptom. For this, aspirin may be sometimes consumed to ease a headache. But this can increase the risk of Reye Syndrome exponentially. While someone has any flu, it is not recommended at all to consume aspirin for him/her.
  • Many patients often do not know that they have fatty acid oxidation disorder where their body is unable to break the fatty acids. In this case, the flu or chicken pox can trigger the underlying fatty acid oxidation disorder and the risks of having Reye Syndrome increases.

Diagnosing Reye Syndrome

For its limited reports, Reye Syndrome can often be diagnosed as something else, including meningitis (which is the disease where the surrounding membranes of spinal cord and brain get affected), encephalitis (or the inflammation of the brain).

It is important, and then the proper diagnosis is important so that treatment can be started as early as possible.

There are several ways to diagnose Reye Syndrome, they are:

  • Blood test: Blood tests along with urine tests can determine if there is any toxic buildup in the blood. Blood tests are also important to check if the liver is properly functioning.
  • CT scan: An advanced imaging test is required to check for any abnormalities in the brain, such as swelling.
  • Liver biopsy: In this test, a sample of liver tissue is collected to properly look for any functioning abnormalities which can indicate Reye Syndrome.
  • Lumbar puncture: In this process, a needle is used to take a sample of the patient’s spinal fluid. It is important to examine the fluid for the presence of any bacteria or virus.

Prevention of Reye Syndrome

  • As there is a strong link between aspirin and the emergence of Reye syndrome, one should not provide children under 16 with aspirin and not only aspirin, any medication which has aspirin as its ingredient.

It is always advisable to check the ingredients before buying any medicine for children. Aspirin has other names also, such as acetylsalicylic acid, acetylsalicylate, salicylic acid, salicylate etc. Consultation with a physician is mandatory before buying any medication for children.

To treat viral illnesses such as chicken pox or flu, it is commendable to give children ibuprofen, acetaminophen instead of aspirin. These are relatively safer than aspirin for children. But it should be kept in mind that too much use of acetaminophen can damage the liver, so, overuse of medication is strictly forbidden.

However, children with Kawasaki disorders may need to continue medication which may contain aspirin. If that is the case, it is a mandate to make sure that the child’s vaccination is up to date.

  • In some hospitals, newborn screening is conducted to determine if they have fatty acid oxidation disorder or not. Determining this can be proven to be helpful later.

Treatment of Reye Syndrome

As Reye Syndrome is considered as a medical emergency, the child should be immediately admitted to an intensive care unit as soon as it is diagnosed.

There is no cure for Reye Syndrome as yet, but the treatment focuses on the reduction of the symptoms. The child also needs treatment which can support the body’s vital functions, such as breathing and blood circulation.

As Reye Syndrome affects the brain, the swelling of the brain needs to be addressed too.

There are some medicines which can be provided to the child intravenously.

  • Fluids: Fluids and electrolytes containing salts, minerals, and nutrients can be injected into the body.
  • Diuretics: These are medications which help the body to get rid of the excess fluid.
  • Corticosteroids: These help to reduce the swelling of the brain.
  • Ammonia detoxicants: In certain cases, ammonia levels of the body can be increased. It is important to reduce the level of ammonia to minimise the symptoms of Reye Syndrome.
  • Anticonvulsants: As noted already, Reye Syndrome has convulsion as one of its symptoms, and it is important to treat the convulsion with the proper medication.

If it is needed, a child may be provided with a ventilator if he/she has breathing problems.

Complications

Among the reported cases, 80 per cent of children gains full recovery. But there can be some complication which can emerge over time. The most important of these include:

  • Loss of vision or memory.
  • Difficulties while speaking
  • Problems regarding movement and posture
  • Poor memory and difficulty to pay attention.

These long-term difficulties can resurface as Reye Syndrome affects the brain. If the child has any of these problems while growing up, he/she can be part of a specialised care course. The treatment of these difficulties can change as they grow up.

Remedies

A proper and balanced diet is the secret of good health for any child. And as Reye Syndrome mostly happens after a viral disease, it is commendable to protect the children from any viral disease.

Also, being dependent on medicines too much can be harmful to any child’s health. Try not to overuse drugs, and if medication is totally necessary, then a physician should be contacted for proper consultation.

Children are healthier when they get to play. A proper meal and playing can make a child healthy and thus, dependency on the medicines can be decreased.

 

Reye Syndrome can be a rare disease and can have many complications, but if proper preventive measures can be taken, then it can be certainly avoided. Also, it is recommendable to prepare a newborn child for a fatty acid oxidation disorder screening to determine if he/she has the disease. One needs to provide the child with proper medication as unsolicited medication can harm the child.

Sagar Papneja

For me, health is about sustainable living and consuming environmentally conscious food; I am a vegan.