How is stage 0-1 Reye syndrome treated?

Updated: Apr 02, 2018
  • Author: Debra L Weiner, MD, PhD; Chief Editor: Kirsten A Bechtel, MD  more...
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Answer

Keep the patient quiet. Frequently monitor vital signs and laboratory values. Correct fluid and electrolyte abnormalities, hypoglycemia, and acidosis. If the patient is hypoglycemic, administer dextrose 25% as an intravenous (IV) bolus in a dose of 1-2 mL/kg. The use of bicarbonate to correct acidosis is controversial because of potential paradoxical cerebrospinal fluid (CSF) acidosis. In view of the lack of data regarding the degree of acidosis for which bicarbonate should be administered and the appropriate dosage, guidelines can only be suggested. If the initial pH is less than 7.0-7.2, consider administering sodium bicarbonate 0.5-2 mEq/kg/h to correct it to 7.25-7.3, with the dosage based on the deficit, calculated as follows:

Deficit in HCO3 (mEq) = weight (kg) × base excess × 0.3

Avoid rapid correction or overcorrection. Recognize that administration of sodium bicarbonate results in a significant sodium load.

Maintain electrolytes, serum pH, albumin, serum osmolality, glucose, and urine output in normal ranges. Consider restricting fluids to two thirds of maintenance. Overhydration may precipitate cerebral edema. Use colloids (eg, albumin) as necessary to maintain intravascular volume. Dehydration may compromise cardiovascular volume and reduce cerebral perfusion. Glucose should be maintained in the 100-125 mg/dL range; this will require administration of D10 or D20. Place a Foley catheter to monitor urine output.

Consider giving ondansetron 1-2 mg IV every 8 hours to decrease vomiting. Antacids may also be administered for gastrointestinal (GI) protection.


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