Reye’s Syndrome

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Hey everybody, in this lesson we are going to talk about Reye syndrome. Dictionaries indicate that this can be pronounced two ways, either “Rye” (like rye bread) or “Ray” so, you can take your pick! I’m going to go with “Rye”

Reye Syndrome is pretty rare, but it’s a very serious disease of the brain that progresses rapidly. It also affects the liver and there is usually a history of a viral infection (often chickenpox). There is also an association with the patient having taken aspirin to help with symptoms of the viral infection.

It isn’t fully understand why this damage is happening, but it results in edema and inflammation that leads to a neurological decline that can quickly become fatal. The CDC has developed a system to classify this rapid progression in stages 0-6.

Anytime a disease is known for progression rapidly, it’s super important to know how to recognize it early on. For Reye syndrome what you are looking for is vomiting that comes on really quickly, with a history of viral illness within the last couple weeks.

Neuro symptoms usually present 24-48 hours after the vomiting. What we need to be on the lookout for here are signs of increased intracranial pressure. I cover signs of this in the meningitis lesson, so check that out, but the main thing I want you to remember is that younger kids and infants can’t tell you when they feel weird, or when they have a headache. Lethargy and poor feeding are super important signs, but they are pretty non-specific. More specific signs are high-pitched, inconsolable crying and bulging fontanelles.

Then beyond that, you can see a rapid neurological decline, so we’re talking, seizures, drastic changes in level of consciousness, comas, and in the worst case, brain herniation from the pressure being so great in the brain. If this happens you may see dilated pupils and abnormal posturing.

These patients are likely to have very abnormal blood work- they may have low blood sugar, elevated ammonia levels and prolonged bleeding time. These two are happening because the liver isn’t functioning properly. Ammonia is a waste product that the liver usually helps the body get rid of. When the liver doesn’t get rid of it, and ammonia levels build up, patients become confused and lethargic. The liver is also responsible for producing clotting factors, so as the liver is damaged, the bodies ability to form clots is decreased causing a prolonged bleeding time.

There isn’t really a direct treatment for Reye Syndrome. Management is all about giving supportive care and monitoring the patient very closely. Supportive care will start with ABC’s. Remember hypoglycemia is common so make sure to check the glucose. In emergency situations you can always remember after your ABC’s you have DEFG which is don’t ever forget glucose!

Careful management of fluids and electrolyte are very important in preventing further complications. Frequent neuro checks are essential to keep an eye out for signs of increasing ICP. And these patients need to be on seizure precautions and bleeding precautions

Your priority nursing concepts are intracranial regulation, clotting and health promotion.
Okay, let’s recap! Reye Syndrome is a disease that isn’t fully understood where the brain and liver are damaged. It’s pretty rare, but severe and life threatening when it happens.

It is usually preceded by a viral illness and the patient having taken aspirin. Patient education is key to help prevent Reye syndrome from happening- kids should not take medications that have salicylate in them. the main ones are aspirin and pepto-bismol!

The first symptom of reye syndrome is usually vomiting and neuro symptoms follow in 1-2 days.

The most common problems to come up are dehydration, elevated ammonia levels, bleeding and brain herniation from the increased ICP.

Treatment is supportive and very closely monitoring neuro and fluid status.

That's it for our lesson on Reye Syndrome. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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