Student Nurse Laura

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From Tabers: Why shouldn’t you give Aspirin to a child who has viral symptoms?

Posted by Laura on November 15, 2010

Reye’s syndrome

[R. D. K. Reye, Australian pathologist, 1912–1977]
A syndrome marked by acute encephalopathy and fatty infiltration of the liver and often of the pancreas, heart, kidney, spleen, and lymph nodes.
It is seen primarily in children under age 18, after an acute viral infection such as chickenpox or influenza. The mortality rate depends on the severity of the central nervous system involvement but may be as high as 80%. Fortunately, the disease occurs rarely. The cause of the disease is unknown, but association with increased use of aspirin and other salicylates is evident from epidemiological studies.
See: Nursing Diagnoses Appendix

SYMPTOMS
The patient experiences a viral infection with a brief recovery period, followed in about 1 to 3 days by severe nausea and vomiting, a change in mental status (disorientation, agitation, coma, seizures), and hepatomegaly without jaundice in 40% of cases. The disease should be suspected in any child with acute onset of encephalopathy, nausea and vomiting, or altered liver function, esp. after a recent illness. The severity of the syndrome depends on how badly the brain swells during the illness, reflected in increased intracranial pressure (ICP).

Aspirin and other salicylates should not be used for any reason in treating children under age 18 with viral infections.

TREATMENT
Supportive care includes intravenous administration of fluids and electrolytes, administration of corticosteroids, and ventilatory assistance. Electrolytes should be controlled carefully, along with serum glucose and ammonia levels, and neurological status.

PATIENT CARE
Increased ICP resulting from increased cerebral blood volume results in intracranial hypertension. To decrease intracranial pressure and cerebral edema, fluids are provided at 2/3 maintenance level and an osmotic diuretic or furosemide is prescribed. The head of the bed is kept at a 30-degree angle. Fluid intake should maintain urine output at 1.0 ml/kg/hour, plasma osmolality at 290 mOsm (normal to high), and blood glucose at 150 mg/ml (high), while preventing fluid overload. Proteins are restricted to keep ammonia levels low. Hypoprothrombinemia (resulting from liver injury) is treated with vitamin K, or fresh frozen plasma if needed. Temperature is monitored, and prescribed measures to alleviate hyperthermia are instituted. Seizure precautions are also instituted. Intake and output are monitored carefully. The patient is observed for evidence of impaired hepatic function, such as signs of bleeding or encephalopathy. All treatments are explained to parents and support is provided to them. The National Reye’s Syndrome Foundation provides information and support.

 

All material is from Tabers at: http://www.tabers.com/tabersonline/ub/view/Tabers/143910/24/Reye%27s_syndrome

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