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aspirin and Reye syndrome

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121. Pneumonia, Viral (Diagnosis)

in otherwise healthy children but does occur in immunocompromised children. Complications include secondary bacterial infections, encephalitis, hepatitis, and, with concomitant aspirin use, Reye syndrome. VZV pneumonia also tends be more severe in individuals who smoke. Measles virus virus is a member of the Paramyxoviridae family and the genus Morbillivirus . It is a single-stranded RNA virus contained within a nucleocapsid and surrounded by an envelope. Measles is a respiratory tract virus that causes (...) , below). Six human coronaviruses (HCoVs) have now been identified: HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1, SARS-COV (which causes severe acute respiratory syndrome), and MERS-COV (Middle East respiratory syndrome). These HCoVs appear to be established human pathogens with worldwide distribution, causing upper and lower respiratory tract infections, especially in children. Typically, HCoV infection follows a seasonal pattern similar to that of influenza, although Hong Kong researchers found

2014 eMedicine.com

122. Pruritus and Systemic Disease (Diagnosis)

syndrome. Perhaps some combination of the pruritogenic substances mentioned above (ie, bile salts, histamine, opioids) induces cholestatic pruritus. Hematologic pruritus Iron is a critical factor in many enzymatic reactions. Although iron deficiency has not been proved to be a cause of pruritus, it may contribute to pruritus through a variety of metabolic paths. Patients with pruritus and iron deficiency may not be anemic; this observation suggests that pruritus may be related to iron (...) and not hemoglobin. Patients with have increased numbers of circulating basophils and skin mast cells, which have been correlated with itching. The itch typically occurs during cooling after a hot shower. Mast cell prostaglandins and increased platelet degranulation, which lead to the release of serotonin and prostanoids, are thought to be important mediators of itching, along with iron deficiency, which may be a contributing factor. The fact that aspirin and paroxetine alleviate this form of pruritus suggests

2014 eMedicine.com

123. Upper Respiratory Tract Infection (Diagnosis)

. Lymphadenitis may follow or accompany URI. Guillain-Barré syndrome may manifest as an ascending polyneuropathy a few days or weeks after a URI. In children or adolescents, the use of aspirin during a viral infection may rarely cause Reye syndrome. Aspirin is contraindicated for the management of fevers in children or adolescents. URI, especially with fever, may increase the work of the heart, adding strain to persons with suboptimal cardiovascular status, and can lead to cardiovascular decompensation (...) > Upper Respiratory Tract Infection Updated: Jun 21, 2018 Author: Anne Meneghetti, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP Share Email Print Feedback Close Sections Sections Upper Respiratory Tract Infection Overview Practice Essentials Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting. URIs range from the common cold—typically a mild, self-limited, catarrhal syndrome of the nasopharynx—to life-threatening illnesses

2014 eMedicine.com

124. Toxicity, Salicylate (Diagnosis)

. Repackaging has decreased children's accessibility to lethal amounts, and salicylate's association with Reye syndrome has significantly decreased its use. Still, more than 10,000 tons of aspirin are consumed in the United States each year. Aspirin or aspirin-equivalent preparations (in milligrams) include children's aspirin (80-mg tablets with 36 tablets per bottle), adult aspirin (325-mg tablets), methyl salicylate (eg, oil of wintergreen; 98% salicylate), and Pepto-Bismol (236 mg of non-aspirin (...) to moderate pain. Aspirin is used as an antipyretic and as an anti-inflammatory agent for the treatment of soft tissue and joint inflammation and vasculitides such as acute rheumatic fever and Kawasaki disease. Aspirin is also used to treat acute coronary syndrome. Low-dose aspirin helps to prevent thrombosis. Acetylsalicylic acid is colorless or white in crystalline, powder, or granular form. The chemical is odorless and is soluble in water. Salicylate is available for ingestion as tablets, capsules

2014 eMedicine.com

125. Drug-Induced Hepatotoxicity (Follow-up)

, myalgia, stiffness, weakness, elevated creatine kinase level) Procainamide - Antinuclear antibodies (ANAs) Gold salts, propylthiouracil, chlorpromazine, chloramphenicol - Marrow injury Amiodarone, nitrofurantoin - Associated pulmonary injury Gold salts, methoxyflurane, penicillamine, paraquat - Associated renal injury Tetracycline - Fatty liver of pregnancy Contraceptive and anabolic steroids, rifampin - Bland jaundice Aspirin - Reye syndrome Sodium valproate - Reyelike syndrome Pathological (...) or Gilbert syndrome. Conjugated hyperbilirubinemia (>50% of the total bilirubin is direct) suggests hepatocellular dysfunction or cholestasis. When the bilirubin level is above 25-30 mg/dL, extrahepatic cholestasis is an unlikely diagnosis; because the predominantly conjugated bilirubin is water soluble, it is easily excreted by the kidney in extrahepatic cholestasis. Subfulminant hepatic failure most commonly results from acetaminophen, halothane, methoxyflurane, enflurane, trovafloxacin, troglitazone

2014 eMedicine.com

126. Dengue (Follow-up)

and supportive care, fatalities are rare. Convalescence is slow. Aspirin and NSAIDs are discouraged owing to potential platelet dysfunction causing bleeding. Children who receive aspirin are at risk of developing Reyes syndrome; therefore, they should never receive aspirin when Dengue fever is suspected. The mortality rate of DSS is reported to be 2%. Exposure to a serotype besides the 4 mentioned can lead to DHF or DSS, which have serious complications and may be fatal. DSS can occur after DHF (...) in limited areas of Africa. Previous Next: Epidemiology Occurrence in the United States In the continental United States, dengue occurs only in the season when mosquitoes breed actively (warm weather). Since the 1970s, outbreaks of dengue fever, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) have increased in frequency and severity in the Caribbean and the Americas. In the past 2 years, an increasing number of reports of dengue fever have occurred in the United States, particularly from

2014 eMedicine.com

127. Upper Respiratory Tract Infection (Follow-up)

themselves. [ ] Adjunctive therapy for strep pharyngitis includes pain relievers; aspirin should be avoided in children due to risk of Reye syndrome. Corticosteroids are not recommended. [ ] Previous Next: Herpetic or Gonococcal Pharyngitis Specific therapies are available for gonococcal and herpes simplex virus (HSV) pharyngitis. Gonococcal pharyngitis may be difficult to eradicate. Gonococcal therapy is typically a single intramuscular dose of ceftriaxone. Although coincident Chlamydia trachomatis (...) to reduce discomfort due to cough. Avoid aspirin in children with viral illness because aspirin is associated with Reye syndrome. Inhaled cromolyn sodium is used for control of chronic asthma. Data are insufficient to permit evidence-based recommendations regarding the use of inhaled cromolyn sodium to treat URI-related cough in patients without asthma. Fever and discomfort relief Fever may be physiologically helpful in eliminating pathogens from the body. In some individuals, however, fever poses

2014 eMedicine.com

128. Takayasu Arteritis (Follow-up)

arteritis. is treated with antihypertensive agents, and aggressive therapy is necessary to prevent complications. Low-dose aspirin may have a therapeutic effect in large vessel vasculitis. Antiplatelet agents and heparin may prove useful in preventing stroke. Warfarin also has been used. The literature reports a case of improvement in renal and systemic function with low-dose intravenous (IV) heparin therapy (10,000 U/d) followed by oral anticoagulant and antiplatelet agents. Pregnancy Pregnancy (...) with Takayasu's arteritis is impaired and comparable with rheumatoid arthritis and ankylosing spondylitis patients. Clin Rheumatol . 2008 Jul. 27(7):859-65. . Maksimowicz-McKinnon K, Clark TM, Hoffman GS. Limitations of therapy and a guarded prognosis in an American cohort of Takayasu arteritis patients. Arthritis Rheum . 2007 Mar. 56(3):1000-9. . Soto ME, Espinola N, Flores-Suarez LF, Reyes PA. Takayasu arteritis: clinical features in 110 Mexican Mestizo patients and cardiovascular impact on survival

2014 eMedicine.com

129. Kawasaki Disease (Follow-up)

the use of aspirin in children with KD as part of their treatment regimen. [ ] Patients who remain on long-term, low-dose aspirin should receive an annual influenza vaccine and be vaccinated against varicella. Additionally, the risks of developing Reye syndrome during an active infection with influenza or varicella should be addressed. Clopidogrel (Plavix) may be briefly substituted for aspirin in patients who develop influenza or varicella. This agent can also be used in patients allergic to aspirin (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTY1MzY3LXRyZWF0bWVudA== processing > Kawasaki Disease Treatment & Management Updated: Jul 30, 2018 Author: Tina K Sosa, MD; Chief Editor: Russell W Steele, MD Share Email Print Feedback Close Sections Sections Kawasaki Disease Treatment Approach Considerations The principal goal of treatment for KD is to prevent coronary artery aneurysms and other cardiac complications. The mainstays of treatment for KD are IVIG and aspirin. [ , , ] All patients with KD should be admitted to the hospital for administration of IVIG

2014 eMedicine.com

130. Viral Infections of the Mouth (Follow-up)

multiforme. [ ] Patients should be counseled about the routes of infectivity. Medical care for primary HHV-1/HHV-2 The goals of treatment are to make the patient comfortable and to prevent secondary infections or worsening systemic illness. The patient should maintain fluid intake and a balanced diet with the use of liquid food replacement if necessary. Analgesics, such as acetaminophen, may make the patient more comfortable. Aspirin should be avoided in pediatric patients because of the possibility

2014 eMedicine.com

131. von Willebrand Disease (Follow-up)

, Rand ML, Bouskill V, Reyes JT, et al. Idiopathic pulmonary arterial hypertension - a unrecognized cause of high-shear high-flow haemostatic defects (otherwise referred to as acquired von Willebrand syndrome) in children. Br J Haematol . 2018 Aug 23. . Byams VR, Kouides PA, Kulkarni R, et al. Surveillance of female patients with inherited bleeding disorders in United States Haemophilia Treatment Centres. Haemophilia . 2011 Jul. 17 Suppl 1:6-13. . Sanders YV, Giezenaar MA, Laros-van Gorkom BA, Meijer (...) during the first week post partum. Deterrence Advise patients to avoid aspirin-containing compounds. In addition, patients should be wary of any physical activity associated with an increased risk of hemorrhage. Next: Type I von Willebrand disease DDAVP is the treatment of choice for individuals with vWD type I. The infusion of DDAVP into healthy individuals and individuals with vWD type 1 results in a rapid increase in circulating levels of vWF:Ag and FVIII and RCoF activity. Typically, a maximal

2014 eMedicine.com

132. Head Injury (Follow-up)

disability, but all these patients also had either radiological abnormalities or focal neurological signs, placing them in the more severe range of mild head injuries. [ ] A recent review sponsored by the National Institute of Medicine concluded that there is no clear evidence of lasting cognitive impairments attributable to mild closed head injuries. [ ] Second impact syndrome In the United States, athletic competitions account for 300,000 mild head injuries per year. The second impact syndrome occurs (...) when an athlete suffers a minor concussion and subsequently is re-injured in play. The repeated concussive events are theorized to result in autoregulatory dysfunction and vascular congestion. Catastrophic brain edema, herniation, and sudden death may ensue. At least 35 cases occurred among US football participants from 1980–1993, but the general incidence of this syndrome is unknown. Concerns about athletes at risk returning to play too soon have generated formalized recommendations from

2014 eMedicine.com

133. Pruritus and Systemic Disease (Follow-up)

and is effective but may only be available in intravenous form. [ ] To prevent opioid withdrawal syndrome, low starting doses should be used. These drugs should not be used in patients in need of palliative opioid treatment. Butorphanol, which antagonizes the mu receptor but agonizes the kappa receptor, has been shown to be effective in suppressing cholestatic pruritus. [ ] Ursodeoxycholic acid and S-adenosyl-L-methionine have both been reported to decrease pruritus in women with cholestasis of pregnancy (...) vera may benefit from aspirin, which is considered the first-line therapy. Cimetidine, danazol, cholestyramine, UV-B light therapy, and psoralen with UV-A therapy have all been shown to help. [ , ] Interferon-alfa may provide relief, but its adverse effects may decrease compliance. [ ] Treatment with paroxetine at 20 mg/d has been shown to be effective, but further clinical trials are needed. One patient with severe pruritus due to Hodgkin disease responded dramatically to thalidomide at 200 mg

2014 eMedicine.com

134. Rhinoviruses (Follow-up)

appropriate handwashing, avoidance of finger-to-eyes or finger-to-nose contact, and use of nasal tissue. One study suggested that hand cleansers with salicylic acid and pyroglutamic acid prevent the transmission of rhinovirus and reduce the number of patients who become clinically infected. [ ] When a child has a viral illness, aspirin administration should be avoided to prevent Reye syndrome (though this is rare). Previous References Busse WW, Gern JE, Dick EC. The role of respiratory viruses in asthma (...) . 178(7):667-72. . . Gern JE. Rhinovirus and the initiation of asthma. Curr Opin Allergy Clin Immunol . 2009 Feb. 9(1):73-8. . . Martinez FD. The origins of asthma and chronic obstructive pulmonary disease in early life. Proc Am Thorac Soc . 2009 May 1. 6(3):272-7. . . Calvo C, Casas I, García-García ML, Pozo F, Reyes N, Cruz N, et al. Role of rhinovirus C respiratory infections in sick and healthy children in Spain. Pediatr Infect Dis J . 2010 Aug. 29(8):717-20. . Rosenthal LA, Avila PC, Heymann PW

2014 eMedicine.com

135. Drug-Induced Hepatotoxicity (Treatment)

, myalgia, stiffness, weakness, elevated creatine kinase level) Procainamide - Antinuclear antibodies (ANAs) Gold salts, propylthiouracil, chlorpromazine, chloramphenicol - Marrow injury Amiodarone, nitrofurantoin - Associated pulmonary injury Gold salts, methoxyflurane, penicillamine, paraquat - Associated renal injury Tetracycline - Fatty liver of pregnancy Contraceptive and anabolic steroids, rifampin - Bland jaundice Aspirin - Reye syndrome Sodium valproate - Reyelike syndrome Pathological (...) or Gilbert syndrome. Conjugated hyperbilirubinemia (>50% of the total bilirubin is direct) suggests hepatocellular dysfunction or cholestasis. When the bilirubin level is above 25-30 mg/dL, extrahepatic cholestasis is an unlikely diagnosis; because the predominantly conjugated bilirubin is water soluble, it is easily excreted by the kidney in extrahepatic cholestasis. Subfulminant hepatic failure most commonly results from acetaminophen, halothane, methoxyflurane, enflurane, trovafloxacin, troglitazone

2014 eMedicine.com

136. Pruritus and Systemic Disease (Treatment)

and is effective but may only be available in intravenous form. [ ] To prevent opioid withdrawal syndrome, low starting doses should be used. These drugs should not be used in patients in need of palliative opioid treatment. Butorphanol, which antagonizes the mu receptor but agonizes the kappa receptor, has been shown to be effective in suppressing cholestatic pruritus. [ ] Ursodeoxycholic acid and S-adenosyl-L-methionine have both been reported to decrease pruritus in women with cholestasis of pregnancy (...) vera may benefit from aspirin, which is considered the first-line therapy. Cimetidine, danazol, cholestyramine, UV-B light therapy, and psoralen with UV-A therapy have all been shown to help. [ , ] Interferon-alfa may provide relief, but its adverse effects may decrease compliance. [ ] Treatment with paroxetine at 20 mg/d has been shown to be effective, but further clinical trials are needed. One patient with severe pruritus due to Hodgkin disease responded dramatically to thalidomide at 200 mg

2014 eMedicine.com

137. Head Injury (Treatment)

. . Hefny AF, Eid HO, Abu-Zidan FM. Severe tyre blast injuries during servicing. Injury . 2009 May. 40(5):484-7. . Bhattacharjee Y. Neuroscience. Shell shock revisited: solving the puzzle of blast trauma. Science . 2008 Jan 25. 319(5862):406-8. . Belanger HG, Kretzmer T, Yoash-Gantz R, Pickett T, Tupler LA. Cognitive sequelae of blast-related versus other mechanisms of brain trauma. J Int Neuropsychol Soc . 2009 Jan. 15(1):1-8. . Reymond MA, Marbet G, Radu EW, et al. Aspirin as a risk factor (...) study. AJNR Am J Neuroradiol . 2008 Mar. 29(3):514-9. . Niogi SN, Mukherjee P, Ghajar J, Johnson C, Kolster RA, Sarkar R. Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: a 3T diffusion tensor imaging study of mild traumatic brain injury. AJNR Am J Neuroradiol . 2008 May. 29(5):967-73. . Dailey NS, Smith R, Bajaj S, Alkozei A, Gottschlich MK, Raikes AC, et al. Elevated Aggression and Reduced White Matter Integrity in Mild

2014 eMedicine.com

138. Pharyngitis, Viral (Treatment)

. [ ] Analgesics and antipyretics may be used for relief of pain or pyrexia. Acetaminophen is the drug of choice. Traditionally, aspirin has been used, but it may increase viral shedding. Aspirin should not be used in children or adolescents, especially with influenza, because of its association with Reye syndrome. One study proved that ibuprofen was superior to acetaminophen for symptomatic relief in children aged 6-12 years. A double-blind randomized study involving adult patients from 27 study centers (...) disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury) Persons with immunosuppression, including that caused by medications or by HIV infection Women who are pregnant or postpartum (within 2 weeks after delivery) Persons younger than 19 years who are receiving long-term aspirin therapy American Indians/Alaska Natives Persons

2014 eMedicine.com

139. Pericarditis, Viral (Treatment)

complete symptom resolution (class I). Consider colchicine as an adjunct to anti-inflammatory therapy for acute recurrent pericarditis (< 5 years: 0.5 mg/day; >5 years, 1.0-1.5 mg/day in two or three divided doses) (class IIa). Consider anti-interleukin 1 agents in the setting of recurrent pericarditis, particularly in corticosteroid-dependent children (class IIb). Avoid aspirin (because of the associated risk of Reye syndrome and hepatotoxicity), as well as corticosteroids (due to severity of side (...) pericarditis may include the following: Reevaluation of recurrent cases Pericardial biopsy Pericardiectomy Continue anti-inflammatory therapy, such as aspirin or indomethacin, for at least several months to monitor the patient’s progress. After therapy is discontinued, 15-30% of patients have a relapse. The optimal method for prevention is not fully established. Accepted modalities include NSAIDs, corticosteroids, immunosuppressive agents, and pericardiectomy. Colchicine has also been tried in some

2014 eMedicine Pediatrics

140. Pericarditis, Bacterial (Treatment)

complete symptom resolution (class I). Consider colchicine as an adjunct to anti-inflammatory therapy for acute recurrent pericarditis (< 5 years: 0.5 mg/day; >5 years, 1.0-1.5 mg/day in two or three divided doses) (class IIa). Consider anti-interleukin 1 agents in the setting of recurrent pericarditis, particularly in corticosteroid-dependent children (class IIb). Avoid aspirin (because of the associated risk of Reye syndrome and hepatotoxicity), as well as corticosteroids (due to severity of side (...) pericarditis may include the following: Reevaluation of recurrent cases Pericardial biopsy Pericardiectomy Continue anti-inflammatory therapy, such as aspirin or indomethacin, for at least several months to monitor the patient’s progress. After therapy is discontinued, 15-30% of patients have a relapse. The optimal method for prevention is not fully established. Accepted modalities include NSAIDs, corticosteroids, immunosuppressive agents, and pericardiectomy. Colchicine has also been tried in some

2014 eMedicine Pediatrics

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