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Reye's syndrome is a rare but serious condition that causes swelling in the liver and brain. Reye's syndrome most often affects children and teenagers recovering from a viral infection and who may also have a metabolic disorder. Signs and symptoms such as confusion, seizures and loss of consciousness require emergency treatment. Early diagnosis and treatment of Reye's syndrome can save a child's life. Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Complications of Reye’s syndrome

Most children and teenagers who have Reye's syndrome survive, although varying degrees of permanent brain damage are possible. Without proper diagnosis and treatment, Reye's syndrome can be fatal within a few days.

Causes of Reye’s syndrome

  • The exact cause of Reye's syndrome is unknown, although several factors may play a role in its development. Reye's syndrome seems to be triggered by using aspirin to treat a viral illness or infection — particularly flu (influenza) and chickenpox — in children and teenagers who have an underlying fatty acid oxidation disorder. Fatty acid oxidation disorders are a group of inherited metabolic disorders in which the body is unable to breakdown fatty acids because an enzyme is missing or not working properly. A screening test is needed to determine if your child has a fatty acid oxidation disorder.
  • In some cases, Reye's syndrome may be an underlying metabolic condition that's unmasked by a viral illness. Exposure to certain toxins — such as insecticides, herbicides and paint thinner — also may contribute to Reye's syndrome.

Signs & Symptoms of Reye’s syndrome

In Reye's syndrome, a child's blood sugar level typically drops while the levels of ammonia and acidity in his or her blood rise. At the same time, the liver may swell and develop fatty deposits. Swelling may also occur in the brain, which can cause seizures, convulsions or loss of consciousness.

The signs and symptoms of Reye's syndrome typically appear about three to five days after a viral infection, such as the flu (influenza) or chickenpox, or an upper respiratory infection, such as a cold. For children younger than age 2, the first signs of Reye's syndrome may be diarrhea and rapid breathing. For older children and teenagers, early signs and symptoms of Reye's syndrome may include:

  • Persistent or continuous vomiting
  • Unusual sleepiness or lethargy

As the condition progresses, signs and symptoms may become more serious:

  • Irritable, aggressive or irrational behavior
  • Confusion
  • Weakness or paralysis in the arms and legs
  • Seizures
  • Loss of consciousness

These signs and symptoms require emergency treatment.

Diagnosis of Reye’s syndrome

There's no specific test for Reye's syndrome. Instead, screening for Reye's syndrome usually begins with blood and urine tests as well as testing for fatty acid oxidation disorders and other metabolic disorders.

Sometimes more invasive diagnostic tests are needed to evaluate other possible causes of liver problems and investigate any neurological abnormalities. For example:

  • Spinal tap (lumbar puncture). A spinal tap can help the doctor identify or rule out other diseases with similar signs and symptoms, such as infection of the lining that surrounds the brain and spinal cord (meningitis) or inflammation or infection of the brain (encephalitis). During a spinal tap, a needle is inserted through the lower back into a space below the end of the spinal cord. A small sample of cerebrospinal fluid is removed and sent to a lab for analysis.
  • Liver biopsy. A liver biopsy can help the doctor identify or rule out other conditions that may be affecting the liver. During a liver biopsy, a needle is inserted through the skin on the upper right side of the abdomen and into the liver. A small sample of liver tissue is removed and sent to a lab for analysis.
  • Computerized tomography (CT) or magnetic resonance imaging (MRI). A head CT or MRI scan can help the doctor identify or rule out other causes of behavior changes or decreased alertness. A CT scan uses a sophisticated imaging machine linked to a computer to produce detailed, two-dimensional images of the brain. An MRI scan uses a strong magnetic field and radio waves rather than X-rays to generate images of the brain.
  • Skin biopsy. Testing for fatty acid oxidation disorders or metabolic disorders may require a skin biopsy.  During a skin biopsy, a doctor takes a small skin sample (biopsy) for analysis in a lab. A biopsy can usually be done in a doctor's office using a local anesthetic.

Treatments of Reye’s syndrome

Reye's syndrome is usually treated in the hospital. Severe cases may be treated in the intensive care unit. The hospital staff will closely monitor your child's blood pressure and other vital signs. Specific treatment may include:

  • Intravenous fluids. Glucose and an electrolyte solution may be given through an intravenous (IV) line.
  • Diuretics. These medications may be used to decrease intracranial pressure and increase fluid loss through urination.
  • Anti-seizure medications. Medications may be used to prevent seizures.
  • Medications to prevent bleeding. Bleeding due to liver abnormalities may require treatment with vitamin K, plasma and platelets.

If your child has trouble breathing, he or she may need assistance from a breathing machine (ventilator).

Prevention of Reye’s syndrome

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This includes plain aspirin and medications that contain aspirin.

Some hospitals and medical facilities conduct newborn screenings for fatty acid oxidation disorders to determine which children are at greater risk of developing Reye's syndrome. Children with known fatty acid oxidation disorders should not take aspirin or aspirin-containing products.

Always check the label before you give your child medication, including over-the-counter products and alternative or herbal remedies. Aspirin can show up in some unexpected places, such as Alka-Seltzer. Sometimes aspirin goes by other names, too, such as:

  • Acetylsalicylic acid
  • Acetylsalicylate
  • Salicylic acid
  • Salicylate

If your child has the flu, chickenpox or another viral illness, use other medications — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) — to reduce high fever or relieve pain.

There's one caveat to the aspirin rule, however. Children and teenagers who have certain chronic diseases, such as Kawasaki disease, may need long-term treatment with drugs that contain aspirin. If your child needs aspirin therapy, make sure his or her vaccines are current — including two doses of the varicella (chickenpox) vaccine and a yearly flu vaccine. Avoiding these two viral illnesses can help prevent Reye's syndrome.

When to seek Medical Advice

Early diagnosis and treatment of Reye's syndrome can save a child's life. If you suspect that your child has Reye's syndrome, it's important to act quickly.

Contact your child's doctor if your child becomes unusually sleepy or lethargic or has sudden behavior changes following a common cold or a bout with the flu or chickenpox.

Seek emergency medical help if your child has seizures or convulsions or loses consciousness.


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