Answer
Factors that increase concern for an IEM include the following:
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No viral prodrome
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No exposure to aspirin or toxin with association to Reye syndrome
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Patients younger than 3 years (in particular, those younger than 1 year)
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Patient or family history of Reye syndrome–like illness
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Preexisting failure to thrive
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Baseline neurologic abnormalities
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Liver dysfunction or elevated ammonia level, particularly if elevated for longer than 1 week with or without waxing and waning
The differential diagnosis includes conditions that can cause vomiting and altered level of consciousness. The distinction between true Reye syndrome and Reye-like syndrome is often unclear.
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