Reye syndrome vs Other pediatric hepatic encephalopathies
How to tell Reye syndrome and Other pediatric hepatic encephalopathies apart when a board question makes them look alike.
Reye is aspirin after viral illness with fatty liver/encephalopathy; other hepatic encephalopathies need metabolic, toxic, infectious, or liver-failure clues.
Side by side
Reye syndrome causes acute encephalopathy and microvesicular fatty liver after viral illness and aspirin exposure, with vomiting, elevated transaminases, and hyperammonemia.
Other hepatic encephalopathies may come from urea cycle defects, acute liver failure, toxins, infection, or metabolic disease without the aspirin-after-viral-illness pattern.
Aspirin metabolites after viral illness impair mitochondrial beta-oxidation, causing microvesicular hepatic steatosis with acute encephalopathy.
Other hepatic encephalopathies may come from urea cycle defects, acute liver failure, toxins, infection, or metabolic disease without the aspirin-after-viral-illness pattern.
The repair move
Before naming the answer, force the stem through the separator: Reye is aspirin after viral illness with fatty liver/encephalopathy; other hepatic encephalopathies need metabolic, toxic, infectious, or liver-failure clues.
Try a free question
CoreA 6-year-old child recovering from influenza A is treated with aspirin for fever. Several days later, he develops persistent vomiting, lethargy progressing to confusion and seizures. Labs: AST 1500, ALT 1200, ammonia 280 mcmol/L, normal bilirubin, normal PT initially. Liver biopsy shows MICROVESICULAR steatosis. Which condition is most likely?
Show answer and explanation
Answer: A. Reye syndrome. Reye syndrome is acute encephalopathy and MICROVESICULAR HEPATIC STEATOSIS following viral illness (especially influenza or varicella) plus aspirin exposure. Aspirin metabolites impair mitochondrial beta-oxidation in liver, causing fatty liver and hyperammonemia, leading to cerebral edema and encephalopathy. Bilirubin is typically NORMAL. High mortality. Supportive care; avoid further aspirin. PREVENTION: AVOID ASPIRIN in children with viral illnesses; use acetaminophen or ibuprofen.
Why the other choices are tempting
- B. Acute viral hepatitis would have elevated bilirubin and different histology.
- C. Acetaminophen toxicity causes centrilobular necrosis, not microvesicular steatosis with the aspirin-viral history.
- D. Urea cycle defects present in neonates or after dietary triggers; orotic acid pattern distinguishes.
- E. Mitochondrial disease is chronic with multisystem features.
Flashcards
Tap a card to flip it.
What clue supports Reye syndrome?
Choose Reye syndrome when the stem gives this pattern: Reye syndrome causes acute encephalopathy and microvesicular fatty liver after viral illness and aspirin exposure, with vomiting, elevated transaminases, and hyperammonemia.
What clue supports Other pediatric hepatic encephalopathies?
Choose Other pediatric hepatic encephalopathies when the stem gives this contrasting pattern: Other hepatic encephalopathies may come from urea cycle defects, acute liver failure, toxins, infection, or metabolic disease without the aspirin-after-viral-illness pattern.
Quick answers
What is the fastest way to tell Reye syndrome from Other pediatric hepatic encephalopathies?
Reye is aspirin after viral illness with fatty liver/encephalopathy; other hepatic encephalopathies need metabolic, toxic, infectious, or liver-failure clues.
What is the key clue for Reye syndrome?
Reye syndrome causes acute encephalopathy and microvesicular fatty liver after viral illness and aspirin exposure, with vomiting, elevated transaminases, and hyperammonemia.
What is the key clue for Other pediatric hepatic encephalopathies?
Other hepatic encephalopathies may come from urea cycle defects, acute liver failure, toxins, infection, or metabolic disease without the aspirin-after-viral-illness pattern.