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aspirin and Reye syndrome

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141. Kawasaki Disease (Treatment)

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 Pediatrics

142. Pericarditis, Viral (Follow-up)

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

143. Pericarditis, Bacterial (Follow-up)

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

144. 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 Pediatrics

145. Head Injury (Diagnosis)

, and primitive reflexes; may be manifestations of a localized contusion or an early herniation syndrome See for more detail. Diagnosis Bedside cognitive testing In the acute setting, measurements of the patient's level of consciousness, attention, and orientation are of primary importance. Some patients acutely recovering from head trauma demonstrate no ability to retain new information. Mental status assessments have validated the prognostic value of the duration of posttraumatic amnesia; patients (...) Trails B test: Allows further qualitative testing of frontal functioning Laboratory studies Sodium levels: Alterations in serum sodium levels occur in as many as 50% of comatose patients with head injuries [ ] ; hyponatremia may be due to the syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt wasting; elevated sodium levels in head injury indicate simple dehydration or diabetes insipidus Magnesium levels: These are depleted in the acute phases of minor and severe head injuries

2014 eMedicine.com

146. Chickenpox (Diagnosis)

and immunocompromised populations. Previous Next: Patient Education Parents of infected children should be instructed to trim their children’s fingernails to minimize skin damage from scratching and the associated complications of bacterial superinfection. Also, it is important to advise parents not to use aspirin for fever control, because the development of Reye syndrome is associated with salicylate administration in children with chickenpox. For patient education resources, see the . Also, see the patient (...) immune globulin (VZIG) is indicated for use in highly susceptible, VZV-exposed immunocompromised or immunosuppressed populations. A live attenuated varicella vaccine (Oka strain) was approved by the US Food and Drug Administration in 1995 for prophylactic use in healthy children and adults. (See , , and .) Next: Background The varicella-zoster virus (VZV) (see the image below) is the etiologic agent of the clinical syndrome of chickenpox (varicella). Zoster, a different clinical entity, is caused

2014 eMedicine.com

147. Dengue (Diagnosis)

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

148. Drug-Induced Hepatotoxicity (Diagnosis)

, 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

149. Pediatrics, Chicken Pox or Varicella (Diagnosis)

rate. Before universal vaccination, most varicella-related deaths in the United States were from associated encephalitis, pneumonia, secondary bacterial infection, and Reye syndrome. (See Complications.) In addition, significant concerns have been raised about the association of varicella with severe invasive group A . [ ] The disease can be serious in neonates, depending on the timing of infection in the mother. Varicella during pregnancy can cause various adverse outcomes for mother and infant (...) , depending on the stage of pregnancy. Neonatal varicella mortality rates can reach 30%. Previous Next: Patient Education Families of children with chickenpox should be instructed to bathe the child regularly to reduce itching and prevent secondary infection. To prevent scratching, which can lead to secondary infection and scarring, the child’s fingernails should be kept short, mittens or socks may be worn on the hands at night, and medication for itching can be given as needed. Aspirin-containing

2014 eMedicine Emergency Medicine

150. Toxicity, Acetaminophen (Diagnosis)

. Next: Background Extensive medical use of acetaminophen began in 1947. Initially in the United States, acetaminophen was available by prescription only. In 1960, this changed to an over-the-counter (OTC) status. The availability of acetaminophen in OTC preparations and the contraindication of aspirin-containing products for pediatric use (due to the association between aspirin and Reye syndrome), have made acetaminophen one of the most commonly used analgesic-antipyretic medications in current (...) acetaminophen should stop using the drug and seek immediate medical care. A review of the medical literature showed the painkiller poses the risk for three rare but potentially fatal skin disorders: Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. [ , ] An intravenous (IV) formulation of acetaminophen (Ofirmev) was approved by the FDA in 2011 for inpatient use in children older than 2 years to treat fever and pain. [ ] Although this article focuses

2014 eMedicine Emergency Medicine

151. Pediatrics, 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 Emergency Medicine

152. 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 Emergency Medicine

153. Viral Infections of the Mouth (Treatment)

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

154. Dengue (Treatment)

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

155. Dengue Fever (Treatment)

. Acetaminophen may be used to treat fever and relieve other symptoms. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided. Management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Single-dose methylprednisolone showed no mortality benefit in the treatment of dengue shock syndrome in a prospective, randomized, double-blind, placebo-controlled trial. [ ] The Novartis Institute for Tropical Diseases (NITD (...) : Tachycardia Prolonged capillary refill time Cool or mottled skin Diminished pulse amplitude Altered mental status Decreased urine output Rising hematocrit Narrowed pulse pressure Hypotension Previous Next: Severe Dengue Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Admission to an intensive care unit is indicated for patients with dengue shock syndrome. Patients may need a central intravenous line for volume replacement

2014 eMedicine.com

156. Rhinoviruses (Treatment)

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

157. Takayasu Arteritis (Treatment)

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

158. Takayasu Arteritis (Treatment)

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

159. Pruritus and Systemic Disease (Overview)

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

160. Kawasaki Disease (Treatment)

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

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