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Reye’s Syndrome

Aubrey freshly had chicken pox. A week forthcoming, her mother afloat noticing that Aubrey is costlyly phlegmatic and has episodes of vomiting. She was brought to the physician and forthcoming a sequence of feature tests, she was guilet out to entertain Reye’s syndrome.


The syndrome was chief picturesquely in 1963 in Australia by RDK Reye and picturesquely a few months succeeding in the United States by GM Johnson.

  • Reye’s syndrome typically appears forthcoming a viral indisposition, in-particular an excellent respiratory repose infection, influenza, varicella, or gastroenteritis, and is associated delay the use of aspirin during the indisposition.
  • Reye’s syndrome is characterized by quick nonprovocative encephalopathy and fatty degenerative liver scarcity.
  • A tinsel lessen in the use of aspirin unordered progeny, in synthesis delay the identification of medication reactions, toxins, and ingrained errors of metabolism (IEMs) that bestow delay Reye’s syndrome–love manifestations, entertain made the idiosyncrasy of Reye’s syndrome greatly worthy.


The pathophysiology of Reye’s syndrome appears as follows:

  • The pathogenesis of Reye’s syndrome, conjuncture not precisely elucidated, appears to complicate mitochondrial defective consequenceing in dysdischarge that inhibits oxidative phosphorylation and fatty-acid beta-oxidation in a bane-infected, sensitized army.
  • The army has usually been unprotected to mitochondrial toxins, most often salicylates.
  • Histologic changes comprise cytoplasmic fatty vacuolization in hepatocytes, astrocyte edema and waste of neurons in the brain, and edema and fatty deterioration of the proximal lobules in the kidneys.
  • All cells entertain pleomorphic, swollen mitochondria that are declining in calculate, concurrently delay glycogen depletion and minimal tissue inflammation.
  • Hepatic mitochondrial dysdischarge consequences in hyperammonemia, which is conceit to induce astrocyte edema, consequenceing in cerebral edema and growthd intracranial hurry (ICP).

Statistics and Incidences

In the United States, despicable surveillance for Reye’s syndrome began in 1973.

  • The peak annual impact of 555 cases reputed to the Centers for Disease Control and Prevention (CDC) was in 1979-1980.
  • Cases of Reye’s syndrome decomposed in calculate forthcoming 1980, when the synod began issuing warnings encircling the contortment among this syndrome and aspirin.
  • Whereas an medium of 100 cases per year were reputed in 1985 and 1986, the climax calculate of cases reputed entire-year among 1987 and 1993 was 36, delay a rank of 0.03-0.06 cases per 100,000 per year.
  • Since 1994, two or fewer cases entertain been reputed entire year.
  • Seasonal transaction initially peaked from December to April, which corcognate delay the peak transaction of viral respiratory catching, in-particular influenza.
  • In the United Kingdom, 597 cases were reputed among 1981 and 1996.
  • After warnings of the contortment among Reye’s syndrome and aspirin were issued in 1986, the impact of Reye’s syndrome lessend substantially, from a dignifyd of 0.63 per 100,000 progeny younger than 12 years in 1983-1984 to 0.11 cases per 100,000 in 1990-1991.
  • Of the 597 cases, 155 were succeeding reclassified, 76 of them as involving an IEM. 
  • Based on US CDC surveillance statistics for 1980-1997 for resigneds younger than 18 years, 1207 cases were reputed in the United States.
  • Incidence peaks among age 5 and 14 years (median, 6 years; average, 7 years); 13.5% were younger than 1 year.
  • The racial disposal of Reye’s syndrome is 93% unspotted and 5% African American, delay the fostering percentage Asian, American Indian, and Native Alaskan.


The causes of Reye’s syndrome comprise the forthcoming:

  • Pathogens. Influenza bane types A and B and varicella-zoster bane are the pathogens most often associated delay Reye’s syndrome.
  • Salicylates. Less than 0.1% of progeny who took aspirin exposed Reye’s syndrome, but gone-by than 80% of resigneds diagnosed delay Reye’s syndrome had enslaved aspirin in the gone-by 3 weeks.
  • Inborn errors of metabolism. IEMs that profit Reye-love syndromes comprise fatty-acid oxidation defects, in-particular medium-chain acyl dehydrogenase (MCAD) and long-chain acyl dehydrogenase want (LCAD) inherited and habitual forms, urea-cycle defects, amino and constitutional acidopathies, pristine carnitine want, and guess-works of carbohydreprove metabolism.

Clinical Manifestations

Signs and symptoms of Reye’s syndrome comprise:

  • Vomiting. Protracted vomiting is seen in resigneds delay or delayout clinically forcible dehydration.
  • Hepatomegaly. Thither is expansion of the liver and fruit in fatty acids which appear in 50% of resigneds.
  • Lethargy. Thither is costly sleepiness or drowsiness journeying to encephalopathy.

The CDC uses the Hurwitz nature but adds grade 6. The grades used in the CDC nature of Reye’s syndrome are as follows:

  • Stage 0. Alert, monstrous truth and laboratory findings compatible delay Reye’s syndrome, and no clinical manifestations.
  • Stage 1. Vomiting, sleepiness, and drowsiness.
  • Stage 2. Restlessness, susceptibility, combativeness, disorientation, delirium, tachycardia, hyperventilation, dilated pupils delay phlegmatic retort, hyperreflexia, substantial Babinski proof, and divert retort to deleterious stimuli.
  • Stage 3. Obtunded, heavy, decorticate inelasticity, and indivert retort to deleterious stimuli.
  • Stage 4. Submerged coma, decerebreprove inelasticity, urban and dilated pupils, waste of oculovestibular reflexes, and dysconjugate regard delay caloric stimulation.
  • Stage 5. Seizures, limber paralysis, listless submerged tendon reflexes (DTRs), no pupillary retort, and respiratory hold.
  • Stage 6. Patients who cannot be classified consequently they entertain been discourseed delay cuworthy or another medication that alters the equalize of perception.

Assessment and Feature Findings

Workup to except ingrained errors of metabolism (IEMs) must be produced and should comprise evaluation for defects of fatty-acid oxidation, amino and constitutional acidurias, urea-cycle defects, and guess-works of carbohydreprove metabolism.

Histopathology of autopsy liver from slip who died of Reye’s syndrome. Hepatocytes are pale-staining due to intracellular fat droplets. Image via: Wikipedia
  • Ammonia equalizes. An ammonia equalize as dignifyd as 1.5 spaces natural 24-48 hours forthcoming the aggression of immaterial foundation changes is the most general laboratory monstrousity.
  • ALT and AST equalizes. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) growth to 3 spaces natural but may revert to natural by grades 4 or 5.
  • Bilirubin equalizes. Bilirubin equalizes are dignifyder than 2 mg/dL (but usually inferior than 3 mg/dL) in 10-15% of resigneds; if the frequented bilirubin equalize is gone-by than 15% of entirety or if the entirety bilirubin equalize exceeds 3 mg/dL, ponder other diagnoses.
  • PT and aPTT equalizes. Prothrombin sstride (PT) and activated peculiar thromboplastin sstride (aPTT) are prolonged gone-by than 1.5-fold in gone-by than 50% of resigneds.
  • Glucose equalizes. Glucose, conjuncture usually natural, may be low, in-particular during grade 5 and in progeny younger than 1 year.
  • Lumbar puncture. If the resigned is hemodynamically established and shows no proofs of growthd intracranial hurry (ICP); chink hurry may or may not be growthd; the unspotted blood cell (WBC) estimate in the cerebrospinal running (CSF) is 8/µL or fewer.

Medical Management

No peculiar texture exists for Reye syndrome; supportive attention is domiciled on the grade of the syndrome.

  • Stage 0-1. Detain the resigned quiet; generally adviser demandful proofs and laboratory values; rectify running and electrolyte monstrousities, hypoglycemia, and acidosis; obey electrolytes, serum pH, albumin, serum osmolality, glucose, and urine output in natural ranks; ponder restricting runnings to two thirds of maintenance; overhydration may thrust-under cerebral edema use colloids (eg, albumin) as demandful to obey intravascular work.
  • Stage 2. The model of attention consists of faithful cardiorespiratory advisering, placement of convenient venous lines or arterial lines to adviser hemodynamic foundation, urine catheters to adviser urine output, ECG to adviser cardiac discharge, and EEG to adviser seizure intelligence; intercept growthd ICP; dignify the gathering to 30°, detain the gathering in a midline orientation, use isotonic rather than hypotonic runnings, and abandon overhydration.
  • Stage 3-5. Continuously adviser ICP, convenient venous hurry, arterial hurry, or end-tidal carbon dioxide; execute endotracheal intubation if the resigned is not already intubated.

Pharmacologic Management

No peculiar texture is profitable for Reye syndrome.

  • Urea cycle guess-work texture agents. Ammonia detoxicants are used for texture of hyperammonemia; they augment elimination of nitrogen; sodium phenylacetate–sodium benzoate is beloved by the US Food and Drug Administration (FDA) for texture of hyperammonemia due to urea-cycle defects and is profitable merely from a point wholesaler, Ucyclyd Pharma, Inc.
  • Antiemetic agents. Antiemetic agents such as ondansetron are administered to lessen vomiting and during the threshold of sodium phenylacetate–sodium benzoate therapy.

Nursing Management

Nursing government for the resigned delay Reye’s syndrome comprise:

Nursing Assessment

Assessment findings for Reye’s syndrome:

  • Stage 1. Lethargy, vomiting and hepatic dysfunction.
  • Stage 2. Hyperventilation, hyperactive reflexes, ecstasy and hepatic dysfunction.
  • Stage 3. Coma, decorticate inelasticity, hyperdisinfectant and hepatic dysfunction.
  • Stage 4. Deepening coma, vast urban pupils, decerebreprove inelasticity and minimal hepatic dysfunction
  • Stage 5. Seizures, limberity, waste of submerged tendon reflexes and respiratory hold (cessation is usually a consequence of cerebral edema or cardiac hold).

Nursing Diagnosis

Based on the assessment grounds, the elder nursing diagnoses are:

  • Deficient running work cognate to scarcity of regulatory means.
  • Ineffective cerebral tissue perfusion cognate to adulterated arterial or venous lineage painser and hypovolemia.
  • Risk for trauma cognate to generalized infirmity, declining coordination, and apprehensive failures.
  • Reduced breathing pattern cognate to lessend earnestness and fatigue, apprehensive impairment, tracheobronchial obstacle, and provocative system.

Nursing Attention Planning and Goals

The elder goals for the resigned are:

  • The resigned gain obey diffuse disinfectant.
  • The resigned gain obey a natural respiratory foundation, as depositiond by natural respiratory reprove.
  • The resigned gain obey orientation to environment delayout deposition of failure.
  • The resigned gain obey peel honor.
  • The resigned gain obey junction disturbance and rank of agitation.

Nursing Interventions

Nursing interventions for the resigned are:

  • Check oxygenation foundation. Adviser demandful proofs and pulse oximetry to determine oxygenation foundation.
  • Monitor ICP. Adviser ICP delay a subarachnoid lay-hold-of or other invasive guile to air-tight assess for growthd ICP.
  • Keep course of the lineage glucose equalizes. Adviser lineage glucose equalizes to expose hyperglycemia or hypoglycemia and to intercept complications.
  • Assess I&O. Adviser running intake and output to intercept running surfeit.
  • Assess overall resigned’s foundation. Assess cardiac, respiratory and neurologic foundation to evaluate the movablesiveness of interventions and adviser for complications such as plunders.
  • Check cardiopulmonary foundation. Assess pulmonary artery catheter hurrys to assess cardiopulmonary foundation.
  • Position the resigned divertly. Detain the gathering of the bed at a 30 quality predilection to lessen ICP and elevates venous revert.
  • Observe seizure provision. Obey plunders provisions to intercept defective.
  • Establish oxygen therapy. Obey oxygen therapy, which may comprise intubation and mechanical disinfectant, to elevate oxygenation and obey thermoregulation.
  • Provide medications. Administer medications as ordered and adviser for redundant movabless to expose complications.
  • Transfuse lineage products. Administer lineage products as ordered to growth oxygen-carrying of lineage and to intercept hypovolemia.
  • Check for neuro problems. Check for waste of reflexes and proofs of limberity to determine quality of neurologic complicatement.
  • Monitor resigned’s weather. Procure a hypothermia blanket as demanded and adviser the client’s weather entire 15 to 30 exact conjuncture the blanket is in use to intercept defective and obey thermoregulation.
  • Provide postoperative attention. Procure postoperative craniotomy attention if demandful to elevate hurt nutritious and to intercept complications.
  • Prevent impaired peel honor. Procure good-natured-natured peel and mouth attention and execute ROM use to intercept change in peel honor and to elevate junction motility.
  • Support the resigned and the source. Be supportive of the source and detain them apprised of the resigned foundation to lessen anxiety.


The goals are met as depositiond by:

  • The resigned obeyed diffuse disinfectant.
  • The resigned obeyed a natural respiratory foundation, as depositiond by natural respiratory reprove.
  • The resigned obeyed orientation to environment delayout deposition of failure.
  • The resigned obeyed peel honor.
  • The resigned obeyed junction disturbance and rank of agitation.

Documentation Guidelines

Documentation for the resigned comprise:

  • Assessment findings, including quality of failure and floating sources of running intake.
  • I&O, running poise, changes in influence, influence of edema, urine peculiar lugubriousness, and demandful proofs.
  • Results of feature studies.
  • Past and fresh truth of injuries, awareness of insurance demands.
  • Use of insurance equipment or procedures.
  • Plan of attention.
  • Teaching guile.
  • Client’s retorts to interventions, instruction, and actions produced.
  • Attainment or journey inverge desired outcomes.
  • Modifications to guile of attention.

Practice Quiz: Reye’s Syndrome

Here’s a 5 ace satire encircling Reye’s Syndrome. If you demand gone-by, scrutinize our NCLEX page.

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1. Reye’s syndrome is a worthy and violent indisposition imposing progeny and teenagers. Its fruit has been linked delay the use of aspirin and which of the forthcoming?

A. Meningitis
B. Encephalitis
C. Strep throat
D. Varicella

1. Answer: D. Varicella

  • D: Reye’s syndrome has been linked delay the ingestion of aspirin in progeny delay viral catching love varicella.
  • A and C: Thither is no contortment among meningitis or bacterial catching such as strep throat and the fruit of Reye’s syndrome.
  • B: Encephalitis is a ingredient of Reye’s syndrome.

2. A 4-year-old hospitalized slip begins to entertain a plunder conjuncture unimpeded delay compactenedened ductile toys in the hallway. Of the forthcoming nursing actions, which one should the nurse do chief?

A. Place the slip in the rectilinear bed.
B. Administer IV medication to slack down the plunder.
C. Place a padded language blade in the slip’s bunghole.
D. Remove the slip’s toys from the contiguous area.

2. Answer: D. Remove the slip’s toys from the contiguous area.

  • D: Since the plunder has already afloat, dot should be distressing into the slip”s bunghole and they should not be moved.
  • A, B, C: Of the choices consecrated, chief guidance would be for insurance.

3. Reye’s syndrome may appear forthcoming kids get aspirin to discourse viral symptoms. Can you call two viral catching?

A. Mumps
B. Varicella
C. Rubeola
D. Influenza

3. Answers: B&D. Varicella and Influenza

  • B&D: Influenza and varicella are two of the most despicable viral catching that head Reye’s syndrome.
  • A&C: Mumps and rubeola worthyly head Reye’s syndrome.

4. What should be consecrated to discourse flu-love symptoms instead of aspirin?

A. Paracetamol
B. Ibuprofen
D. Corticosteroids

4. Answer: B. Ibuprofen

  • B: Ibuprofen and Tylenol may be consecrated to a slip delay Reye’s syndrome instead of aspirin.
  • A, C, D: These drugs are not firm for a slip delay Reye’s syndrome.

5. The physician has ordered Dilantin (phenytoin) for a client delay generalized plunders. When guilening the client’s attention, the protect should:

A. Obey precise intake and output.
B. Check the pulse anteriorly giving the medication.
C. Administer the medication 30 exacts anteriorly meals.
D. Procure verbal hygiene and gum attention entire remove.

5. Answer: D. Provide verbal hygiene and gum attention entire remove.

  • D: Gingival hyperplasia is a verge movables of Dilantin; consequently, the protect should procure verbal hygiene and gum attention entire remove.
  • A, B, C: Answers A, B, and C do not exercise to the medication; consequently, they are loose.

See Also

Related topics to this consider guide:

Further Reading

Recommended media and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Critical Components of Nursing Care


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