Summary
Definition
History and exam
Key diagnostic factors
- vomiting
- altered mental status
Other diagnostic factors
- hyperventilation
- hepatomegaly
- abnormal pupillary response
- hyperreflexia/areflexia
- diminished pain response
- seizures
- absence of, or minimal, jaundice and scleral icterus
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
Diagnostic tests
1st tests to order
- serum electrolytes
- serum glucose
- LFTs
- serum ammonia
- PT/PTT
- urine/serum toxicology
- urinalysis
- blood gas
Tests to consider
- cranial CT
- lumbar puncture with cerebrospinal fluid analysis
- EEG
- liver biopsy
- metabolic testing
Treatment algorithm
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
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.
Differentials
- Head injury
- Acute bacterial meningitis
- Viral meningitis
More DifferentialsGuidelines
- Management of children and young people with an acute decrease in conscious level
- Reye syndrome: 1990 case definition
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