Reye’s Syndrome: Causes, Symptoms, And Treatment

What Is Reye’s Syndrome?

Reye’s syndrome is a rare but potentially life-threatening condition that causes acute inflammation of the brain (encephalopathy) and fatty degeneration of the liver. It most often occurs in children and teenagers recovering from viral infections, such as influenza (flu) or chickenpox. The syndrome triggers abnormal cellular metabolism, leading to fat accumulation in the liver (hepatic steatosis) and brain swelling (cerebral oedema).

The exact cause of Reye’s Syndrome is still not fully understood. Evidence suggests an association between aspirin (salicylate) use during viral illnesses and Reye’s syndrome, as salicylates may disrupt mitochondrial energy metabolism in susceptible children. This leads to a dangerous build-up of toxins in the blood, which in turn affects brain function.

While Reye’s Syndrome is rare today, thanks to greater awareness of avoiding aspirin in children, it remains a medical emergency that requires immediate hospitalisation to prevent long-term complications or death.

Who Is at Risk?

Reye’s syndrome can occur in any age group, but it most often affects children and adolescents recovering from viral infections:

• Children and adolescents between 4 and 16 years recovering from flu, chickenpox, or viral respiratory infections.
• Those who have been given aspirin or salicylate-based medicines for fever or pain relief.
• Individuals with an underlying metabolic disorder, particularly fatty acid oxidation defects that impair energy production.
• Genetic predisposition, where a family history of metabolic or mitochondrial disorders increases susceptibility.
• Children recovering during flu season or winter months, when viral infections are most common.
  Recognising these risk factors early can help parents and caregivers prevent exposure and ensure timely medical intervention.

Causes of Reye’s Syndrome

The precise cause of Reye’s syndrome remains unclear, but mitochondrial dysfunction — impairment of cellular energy production — is believed to play a central role.

According to research summarised by the National Institutes of Health (NIH), aspirin use during viral illness may interfere with mitochondrial function, particularly in genetically predisposed children. This leads to abnormal fat metabolism, resulting in fatty changes in the liver and other organs. As the liver becomes overloaded with fat, it loses its ability to remove toxins like ammonia from the bloodstream. These toxins then accumulate and travel to the brain, causing swelling, pressure, and neurological symptoms.

Children with an inherited metabolic disorder, such as a urea cycle defect or fatty acid oxidation defect, are at greater risk of developing Reye’s syndrome, even without exposure to aspirin.

Symptoms of Reye’s Syndrome

The symptoms of Reye’s syndrome often appear 3 to 5 days after recovery from a viral infection and worsen quickly.

Common signs include:

• Persistent or projectile vomiting not related to food intake.
• Extreme irritability, confusion, or unusual behaviour.
• Lethargy, sluggishness, or difficulty waking up.
• Seizures or convulsions due to brain swelling.
• Rapid or shallow breathing caused by metabolic imbalances.
• Loss of coordination, balance, or slurred speech.
• Loss of consciousness or coma in severe cases.
• Enlarged liver with minimal or no jaundice.
  These symptoms should never be ignored, as Reye’s Syndrome can progress rapidly within hours.

Stages of Reye’s Syndrome

The condition typically progresses through five clinical stages:

1. Stage 1: Persistent vomiting, fatigue, or confusion after a viral illness.
2. Stage 2: Irritability, hyperventilation, and mild liver dysfunction.
3. Stage 3: Disorientation, delirium, and the beginning of seizures.
4. Stage 4: Deepening coma, severe swelling in the brain, and potential organ failure.
5. Stage 5: Loss of reflexes, respiratory arrest, and potential death if not treated immediately.

Recognising Reye’s syndrome in the early stages dramatically improves the chances of full recovery.

How Reye’s Syndrome Affects the Body

Reye’s syndrome causes a cascade of metabolic disturbances. The liver develops fat infiltration, reducing its ability to process toxins, proteins, and fats. The resulting ammonia build-up in the blood crosses into the brain, causing cerebral oedema, swelling that leads to seizures, confusion, or coma.

The syndrome also impacts the pancreas, kidneys, and skeletal muscles, affecting glucose regulation and leading to hypoglycaemia. In severe cases, intracranial pressure can rise to dangerous levels, affecting breathing and heart rhythm.

Without early treatment, these systemic effects can cause multi-organ failure, making immediate medical attention critical.

Diagnosis of Reye’s Syndrome

Diagnosis is based on clinical symptoms, medical history, and laboratory tests. Since Reye’s syndrome mimics other illnesses like meningitis, encephalitis, or toxic ingestion, doctors perform a range of tests, including:

1. Comprehensive medical history (including recent viral infection and aspirin use).
2. Neurological assessment to identify altered mental states or seizures.
3. Liver Function Tests (LFTs) to detect elevated liver enzymes.
4. Blood Ammonia Test to identify metabolic dysfunction.
5. Blood sugar and electrolyte tests to assess metabolic balance.
6. CT or MRI scan to evaluate brain swelling.
7. Liver biopsy, if required, can confirm fatty infiltration and rule out other metabolic or infectious liver conditions.

Early testing helps doctors initiate treatment before irreversible damage occurs.

Tests for Reye’s Syndrome

Advanced diagnostic solutions are used for detecting Reye’s syndrome and related metabolic disorders.

Recommended tests include:

• Liver Function Test (LFT) – to assess enzyme levels and liver health.
• Blood Ammonia and Electrolyte Panel – to evaluate metabolic imbalances.
• Coagulation Profile – to check clotting function in liver-related conditions.
• Metabolic Disorder Screening Panel – to rule out underlying inherited disorders.
• CT/MRI Brain – to detect cerebral oedema.

Treatment for Reye’s Syndrome

There is no specific cure for Reye’s syndrome, but timely medical treatment can save lives. Hospitalisation, often in an intensive care unit, is essential to stabilise the child.

Treatment may include:

• Intravenous (IV) fluids to maintain electrolyte and glucose balance.
• Diuretics such as mannitol are used to reduce brain swelling and intracranial pressure.
• Anticonvulsants to control seizures.
• Corticosteroids are occasionally used to reduce cerebral inflammation, although their benefit remains debated.
• Mechanical ventilation for patients with breathing difficulties.
• Continuous monitoring of liver, brain, and kidney function.
  With early treatment, most patients recover completely without long-term effects.

Possible Complications

Without early diagnosis and treatment, Reye’s syndrome can result in:

• Permanent brain damage due to prolonged swelling.
• Liver failure leading to metabolic instability.
• Respiratory distress or cardiac arrest.
• Learning or developmental disabilities in survivors.
• In rare cases, death due to multi-organ failure.
  Fortunately, with modern diagnostic and intensive care support, survival rates have improved significantly.

Prevention of Reye’s Syndrome

Reye’s syndrome is largely preventable through medication safety and awareness:

• Avoid aspirin or salicylate-containing medicines in anyone under 16 years of age.
• For fever or pain, use paracetamol or ibuprofen instead of aspirin, following medical advice and dosage guidelines.
• Keep all medications labelled and out of children’s reach.
• Ensure your child’s flu and chickenpox vaccinations are up to date.
• Screen for inherited metabolic disorders in high-risk families.
  Public health education on these preventive steps has greatly reduced Reye’s Syndrome cases worldwide.

Living With & Recovery After Reye’s Syndrome

Recovery from Reye’s syndrome depends on how early treatment begins and the severity of brain and liver involvement. Most children treated promptly make a complete recovery.

After hospital discharge, regular follow-ups are necessary to monitor liver function and neurological health. Some children may require rehabilitation therapy to address minor cognitive or motor difficulties.

Emotional support and counselling for families also play an important role, as the experience can be overwhelming for parents and caregivers.

When to See a Doctor

Parents should seek immediate medical help if a child recovering from a viral illness shows:

• Persistent vomiting
• Sudden confusion or unusual behaviour
• Seizures or convulsions
• Rapid breathing or loss of consciousness
  These could be early warning signs of Reye’s syndrome. Early detection and treatment can be lifesaving.

Conclusion

Reye’s syndrome is a preventable medical emergency that requires quick recognition and expert care. While rare, it poses a significant risk to children recovering from viral infections, especially when aspirin is used. Awareness, vaccination, and safe medication habits remain the best lines of defence.

Metropolis Healthcare provides over 4000 diagnostic tests, including comprehensive metabolic and liver panels, full body checkups, and home sample collection with fast and accurate results. With 10,000+ collection touchpoints, easy online booking, and trusted medical expertise, Metropolis ensures accurate diagnosis and continued health monitoring for your loved ones.

FAQs

What causes Reye’s syndrome?

Reye’s syndrome is believed to occur when aspirin is given during a viral infection, particularly in children with an underlying metabolic disorder. This combination disrupts energy metabolism, damaging the liver and brain.

Can adults get Reye’s syndrome?

Yes, but it’s extremely rare. Most cases occur in children and adolescents, as adults tend to have more developed liver enzyme systems that reduce susceptibility.

How is Reye’s syndrome diagnosed?

Reye's syndrome can be diagnosed with a clinical evaluation of recent viral illness and medication history, blood tests for ammonia, liver enzymes, and sugar levels, imaging tests like CT or MRI for brain swelling, and a liver biopsy to confirm fatty changes.

Can Reye’s syndrome be cured?

There is no specific cure, but with early hospital treatment, including fluid therapy and management of brain swelling, most patients make a full recovery.

How can Reye’s syndrome be prevented?

Avoid giving aspirin or salicylate-based drugs to children recovering from viral infections, and ensure they receive recommended flu and chickenpox vaccines.

References

• https://pmc.ncbi.nlm.nih.gov/articles/PMC5195905/
• https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255
• https://my.clevelandclinic.org/health/diseases/6088-reyes-syndrome
• https://medlineplus.gov/ency/article/001565.htm