Pulmonary Manifestations of Reye's Syndrome: A Mechanism of Endogenous Toxicity Producing Acute Respiratory Failure

Reye's syndrome is an acute, noninfectious encephalopathy of children preceded by a virus infection. Characteristic uncontrollable vomiting for 24 to 48 hours in these patients is linked to free fatty acidemia and elevations in blood ammonia as well as other toxic metabolites. These changes coincide with fatty infiltration of vital organs, hepatic failure, elevated intracranial pressure, and respiratory distress. Clinical and histological evidence suggests that acute respiratory failure may be precipitated by toxic pneumonitis, high intracranial pressures, and cerebral hypoxia. No specific therapy has been shown to reduce Reye's syndrome mortality, which may be as high as 75 per cent in untreated patients.