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Reye syndrome

Last reviewed: 13 Apr 2025
Last updated: 19 Apr 2023

Summary

Definition

History and exam

Key diagnostic factors

  • vomiting
  • altered mental status
Full details

Other diagnostic factors

  • hyperventilation
  • hepatomegaly
  • abnormal pupillary response
  • hyperreflexia/areflexia
  • diminished pain response
  • seizures
  • absence of, or minimal, jaundice and scleral icterus
Full details

Risk factors

  • age 5-14 years
  • white ethnicity
  • recent viral infection
  • aspirin (acetylsalicylic acid) and other drug exposure
  • genetically predisposed individual
  • toxin exposure
  • winter/spring presentation
Full details

Diagnostic tests

1st tests to order

  • serum electrolytes
  • serum glucose
  • LFTs
  • serum ammonia
  • PT/PTT
  • urine/serum toxicology
  • urinalysis
  • blood gas
Full details

Tests to consider

  • cranial CT
  • lumbar puncture with cerebrospinal fluid analysis
  • EEG
  • liver biopsy
  • metabolic testing
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Vanessa G. Carroll, MD, FAAP

Medical Director of Pediatric Hospital Medicine

Kootenai Health

Coeur d’Alene

ID

Disclosures

VGC declares that she has no competing interests.

Russell W. Steele, MD, FAAP

Section Head of Pediatric Infectious Diseases

Ochsner Medical Center for Children

New Orleans

LA

Disclosures

RWS declares that he has no competing interests.

Acknowledgements

Dr Vanessa G. Carroll and Dr Russell W. Steele would like to gratefully acknowledge Dr Barry M. Starr, a previous contributor to this topic. BMS declares that he has no competing interests.

Peer reviewers

William F. Balistreri, MD

Professor of Pediatrics

Cincinnati Children's Hospital Medical Center

Cincinnati

OH

Disclosures

WFB declares that he has no competing interests.

Bernard Portmann, MD, FRCPath

Consultant Histopathologist

Institute of Liver Studies

King's College Hospital

London

UK

Disclosures

BP declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centers for Disease Control and Prevention. Reye syndrome: 1990 clinical case definition. 1990 [internet publication].Full text

Hurwitz ES, Nelson DB, Davis C, et al. National surveillance for Reye syndrome: a five-year review. Pediatrics. 1982 Dec;70(6):895-900. Abstract

Belay ED, Bresee JS, Holman RC, et al. Reye's syndrome in the United States from 1981 through 1997. N Engl J Med. 1999 May 6;340(18):1377-82.Full text  Abstract

Royal College of Paediatrics and Child Health. Management of children and young people with an acute decrease in conscious level. Mar 2019 [internet publication].Full text

Hardie RM, Newton LH, Bruce JC, et al. The changing clinical pattern of Reye's syndrome 1982-1990. Arch Dis Child. 1996 May;74(5):400-45. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • Guidelines

    • Management of children and young people with an acute decrease in conscious level
    • Reye syndrome: 1990 case definition
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