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Focal neurologic findings are usually not present. Hepatomegaly occurs in about 40% of cases, but jaundice is absent. Complications include electrolyte and fluid disturbances, diabetes insipidus, syndrome of inappropriate ADH secretion, hypotension, cardiac arrhythmias, bleeding diatheses (especially GI), pancreatitis, respiratory insufficiency, and aspiration pneumonia. Diagnosis Reye's syndrome should be suspected in any child exhibiting the acute onset of an encephalopathy (without known heavy diana mirkin metal or toxin exposure) and pernicious diana mirkin vomiting associated with hepatic dysfunction. Liver biopsy provides the definitive diagnosis and is especially useful in sporadic cases and in young children. The diagnosis may also be made when the typical clinical findings and history are associated with these laboratory findings: increased liver transaminases (AST, ALT > 3 times normal), normal bilirubin, increased blood ammonia level, and prolonged prothrombin time. CSF examination usually shows increased pressure, < 8 to 10 WBC/µL, and normal protein levels; the CSF glutamine level may be elevated.
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