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Platelet Modifying Agents (FETT)

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von Felix C.

Describe the Reye syndrome.

  • Description: a rare type of hepatic encephalopathy that is associated with aspirin use for viral illness in children < 19 years

  • Etiology: aspirin use in individuals < 19 years of age with a febrile illness [14][15]

  • Pathophysiology [16]

    • Viruses alter the metabolism of salicylates → accumulation of salicylate metabolites in the liver → mitochondrial injury and reversible inhibition of enzymes required for fatty acid oxidation → failure of hepatic ATP production → acute hepatic failure → hyperammonemia, metabolic acidosis, and hepatic steatosis → acute encephalopathy

    • Hyperammonemia → cerebral edema → ICP

  • Clinical features

    • Preceding viral infection (e.g., influenza, varicella or viral gastroenteritis): The first symptoms of Reye syndrome usually begin 3–5 days after a viral illness.

    • Acute encephalopathy

      • Severe vomiting

      • Altered mental status (ranging from lethargy to delirium and coma)

      • Neurological symptoms (e.g., seizures, fixed pupils)

    • Liver failure

      • Fatty degeneration

      • Hepatomegaly

  • Diagnostics: clinical diagnosis; further testing to rule out other causes (diagnosis of exclusion)

    • Laboratory studies

      • ↑ AST and ALT

      • Hyperammonemia

      • Hypoglycemia

      • Metabolic acidosis

      • Prolonged INR

    • Cranial CT/MRI: may show cerebral edema and scattered lesions

    • Lumbar puncture and CSF analysis: WBC < 8/μL

    • Liver biopsy: microvesicular hepatic steatosis

  • Treatment: supportive

    • Decrease intracranial pressure (e.g., via osmotic diuresis; elevation of the head)

    • Correction of hypoglycemia

    • Cardiopulmonary support if necessary

  • Prevention

    • Aspirin should be avoided in individuals < 19 years of age, especially those with fever.

    • Exception: children with Kawasaki disease

  • Prognosis

    • Outcomes vary from complete recovery to permanent neurological deficits.

    • Mortality rate: ∼ 20% [12]


Author

Felix C.

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