Reye's syndrome (pronounced "rye's") is a disease that affects children between birth and around fifteen years of age. It is considered a two-phase illness, as it occurs only rarely by itself, but instead usually during recovery (one to fourteen days) after a viral illness. Cold, influenza, chicken pox, and other common childhood diseases are the usual culprits, although any other viral illness can do it as well. External symptoms in rough order of occurrence include persistent nausea and vomiting, personality changes, confusion, convulsions, and finally coma. Because Reye's syndrome onset is so well intertwined with common childhood illnesses, its peak rate coincides with theirs, during the months of January, February, and March.

96 percent of Reye's syndrome cases are found to have used a medication containing aspirin before or during the first three days of the viral illness. Hence, aspirin is usually the second ingredient to the onset of Reye's syndrome. Aspirin is the trade name of acetylsalicylic acid, but other chemicals such as sodium or bismuth salicylate may also cause the onset of Reye's syndrome. Notably, pepto-bismol's active ingredient is bismuth salicylate, so it should be avoided along with aspirin. The usual age at which these drugs may begin being used is sixteen, though paranoid parents and kids might want to wait longer.

The biological chain of cause and effect is not known -- not even in rough approximation, from any source I could find -- but I'm assuming a conflicting hepatic response to infection and aspirin is partially responsible. In any case, the internal symptoms are accumulations of fat in the liver and other organs as well as a severe increase in brain pressure. Damage done through both of these vectors is permanent, and even though 80 percent of Reye's cases survive, nearly all will have problems for this reason. The most common after-effect is mental retardation, occurring in direct proportion to length of time spent in coma during the disease.

Because many of the symptoms of Reye's syndrome parallel more common diseases, it is often misdiagnosed as meningitis, diabetes, or encephalitis. One telltale for a true case of Reye's is an elevation in serum liver enzymes, caused by the Reye's syndrome induced swelling and scarring. The usual test for this measures the enzyme serum glutamic pyruvic transaminase, SGPT. Any ER capable of taking children should have a two or three hour test on hand that measures SGPT, and if you have any doubt at all about your child's diagnosis, the test should be done. Treatment often involves giving IV fluids to provide electrolytes and glucose, as well as dexamethasone to reduce brain swelling, but there is no specific treatment regimen.

Cases of Reye's syndrome were first reported in 1929, but it was not classified as a disease unto itself until Dr. R. Douglas Reye did so in 1963. Even at that time Dr. Reye suspected that it was triggered by some drug or poison, but no common element was found in the children's homes or during autopsy. In the seventies aspirin and the other salicylates were implicated as being partially responsible; by the early eighties the connection had become common knowledge. Because of the increased cultural awareness of Reye's syndrome, the incidence rate dropped from 500 cases in 1977 to 93 in 1985, and today is down to around 50 per year.

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