Viral infections occur among people of all ages, but infants and children are especially susceptible. Most viral infections do not require treatment and patients get better on their own. If they are accompanied with fever and body aches, pain relievers and fever reducers such as acetaminophen and ibuprofen may be given. Aspirin is usually not prescribed for children because of the risk of them developing Reye’s syndrome, a serious and even life-threatening condition.
About Reye’s Syndrome
Reye’s syndrome (RS) is a deadly disease that manifests without warning. Anyone can get it, but it is most common in children between the ages of 2 and 14. Reye’s syndrome usually occurs in persons recovering from a viral infection who have taken aspirin. RS is rare condition capable of affecting all organs of the body, especially the brain and liver. RS increases fluid pressure on the brain and causes the accumulation of excess fat in the liver. RS ranges from mild to severe, but because it is a potentially fatal condition, it should always be considered a medical emergency and treatment sought immediately.
The exact cause of Reye’s syndrome is unknown, but it usually occurs after a week of viral infection, such as influenza and chicken pox or an upper respiratory tract infection. Aspirin and other salicylates (compounds that reduce pain, fever, and inflammation) like antacids and pain relievers can trigger RS. Conversely, pain relievers like acetaminophen and ibuprofen do not increase the chance of getting RS when given to a child.
RS is more likely to occur in children who have fatty acid oxidation disorder, when the body is unable to break down fatty acid due to a missing enzyme. In some children, RS may be latent due to a metabolic condition and is brought out by a viral infection. Exposure to certain insecticides, herbicides, and paint thinners can also activate RS in children.
Symptoms of RS are categorized in five stages.
Stage I starts off with frequent vomiting, sleepiness, and nightmares
In Stage II, patients may hyperventilate and exhibit confusion, irritation, aggression, severe lethargy, and hyperactive reflexes; their speech becomes disordered and they may have hallucinations
In Stage III, RS can progress to coma, cerebral edema (excess water in the brain), and, on the rare occasion, respiratory arrest
By Stage IV, patients enter a deep coma, with large pupils but a reduced response to light, liver dysfunction worsens
In Stage V, respiratory failure occurs, along with seizures, flaccidity (lack of muscle tone), increased ammonia in the blood, and ultimately, death.
Reye’s syndrome is usually suspected in children who exhibit first stage symptoms or persistent vomiting within a week of viral infection, which is followed by intermittent consciousness.
To confirm RS, the doctor runs a blood test to measure liver enzymes, which are usually high in patients with RS. Other changes in the blood include increased levels of ammonia and amino acid, decreased blood sugar, and increased clotting time. A liver biopsy may be performed to check the fat deposits and causes of abnormal liver enzymes. Liver function tests will determine how well the liver is functioning.
A CT scan and MRI of the head is done to check the condition of the brain and to rule out other causes of abnormal behavior. A spinal tap may be performed to rule out meningitis and encephalitis. To look for fatty acid oxidation disorder and metabolic disorder, a skin biopsy may be done.
There is no cure for Reye’s syndrome, but early treatment can help facilitate a successful recovery. Treatment for RS begins with admitting the patient to intensive care, where their fluids, electrolyte balance, nutrition, brain activity, blood pressure, and cardio-respiratory status are closely monitored.
A small amount of insulin may be administered to improve the patient's glucose metabolism. If there is brain swelling, corticosteroids will be prescribed along with diuretics, which decrease fluids. Anti-seizure medication may be given to prevent seizures, and vitamin K is prescribed to improve blood clotting. In serious cases, surgery may be required to reduce pressure in the brain. Patients can survive a serious bout of RS, but sometimes with permanent brain damage.
Reye’s syndrome can be prevented: do not give aspirin to children and teens.
Awareness concerning the connection between Reye’s syndrome and aspirin has greatly reduced the number of RS cases. However, every year, cases of RS still occur.
There are a few, very rare cases where aspirin, antacids, or other medicines containing salicylates are prescribed to children and teens; However, this should only occur when advised to by a doctor and the child remains under the doctor’s close medical supervision.