What is the role of medications in the treatment of Reye syndrome?

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

No specific treatment is available for Reye syndrome. Supportive care should be provided to treat hyperammonemia, hypoglycemia, acidosis, electrolyte disturbances, nausea, vomiting, seizures and increased intracranial pressure.

Corticosteroids are of no proven benefit with regard to managing increased intracranial pressure (ICP) and may even be harmful. Accordingly, they are not indicated in this setting.

The mainstay of treatment is supportive care is based on the clinical stage of the syndrome. Provide aggressive treatment to correct or prevent metabolic abnormalities, particularly hypoglycemia and hyperammonemia, and to prevent or control cerebral edema.

Hyperammonemia treatment consists of sodium benzoate/sodium phenylacetate IV. For highly elevated ammonia levels, hemodialysis may be the appropriate initial treatment if it is readily available, and it is also recommended for patients whose condition fails to respond to initial course of sodium benzoate/sodium phenylacetate. Continuing the administration of sodium benzoate/sodium phenylacetate during hemodialysis may be considered.

Hypoglycemia treatment with dextrose 25% (D25) should be administered to treat hypoglycemia, and, as needed dextrose 10%) (D10) may be provided in IV maintenance fluids infused at 1-1.5 mL/min maintenance to provide 8-12 mg/kg/min. Serum glucose should be maintained in the 120-170 mg/dL range to avoid catabolism. Glucose can be modulated with an insulin dose of 0.2-0.3 units.

For life threatening increased intracranial pressure (ICP), mannitol or hypertonic (3%) saline should be administered. Hypertonic saline should not be given to patients with elevated sodium.


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