Diagnostic criteria from the Centers for Disease Control and Prevention (CDC) are as follows:1,2 Acute noninflammatory

y encephalopathy with an altered level of consciousness (fewer than 10 cells/mmm of cerebrospinal fluid) Hepatic dysfunction with a liver biopsy showing fatty metamorphosis or a more than 3-fold increase in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and/or ammonia levels (200 percent increase in serum transaminase and 150 percentincrease in blood ammonia level) No other explanation for cerebral edema or hepatic abnormality CSF with WBCs (usually lymphocytes) 8/mm3 or fewer (8 X 109/L or fewer) Brain biopsy with cerebral edema without inflammation

DIAGNOSIS Reyes syndrome can be suspected in children or in young subjects with previousviral infection, especially of the respiratory tract, treated with salicylates presenting acute encephalopathy, uncontrollable emesis associated with liver dysfunction.

ARDS Overview Acute respiratory distress syndrome (ARDS) is characterized by the development of sudden breathlessness within hours to days of an inciting event. Inciting events include: trauma, sepsis (microorganisms growing in a person's blood), drug overdose, massive transfusion of blood products, acute pancreatitis, or aspiration (fluid entering the lungs, especially stomach contents). In many cases, the initial event is obvious, but, in others (such as drug overdose) the underlying cause may not be so easy to identify. ARDS typically develops within 12-48 hours after the inciting event, although, in rare instances, it may take up to a few days. Persons developing ARDS are critically ill, often with multisystem organ failure. It is a life-threatening condition; therefore, hospitalization is required for prompt management. ARDS is associated with severe and diffuse injury to the alveolar-capillary membrane (the air sacs and small blood vessels) of the lungs. Fluid accumulates in some alveoli of the lungs, while some other alveoli collapse. This alveolar damage impedes the exchange of oxygen and carbon dioxide, which leads to a reduced concentration of oxygen in the blood. Low levels of oxygen in the blood cause damage to other vital organs of the body such as the kidneys.

Acute respiratory distress syndrome (ARDS) is breathing failure that can occur in critically ill persons with

underlying illnesses. It is not a specific disease. Instead, it is a life-threatening condition that occurs when there is severe fluid buildup in both lungs. The fluid buildup prevents the lungs from working properlythat is, allowing the transfer of oxygen from air into the body and carbon dioxide out of the body into the air. In ARDS, the tiny blood vessels (capillaries) in the lungs or the air sacs (alveoli (al-VEE-uhl-eye)) are damaged because of an infection, injury, blood loss, or inhalation injury. Fluid leaks from the blood vessels into air sacs of the lungs. While some air sacs fill with fluid, others collapse. When the air sacs collapse or fill up with fluid, the lungs can no longer fill properly with air and the lungs become stiff. Without air entering the lungs properly, the amount of oxygen in the blood drops. When this happens, the person with ARDS must be given extra oxygen and may need the help of a breathing machine. Breathing failure can occur very quickly after the condition begins. It may take only 1 or 2 days for fluid to build up. The process that causes ARDS may continue for weeks. If scarring occurs, this will make it harder for the lungs to take in oxygen and get rid of carbon dioxide.

ARDS Symptoms

Severe difficulty in breathing Anxiety Agitation Fever What Are the Signs and Symptoms of Respiratory Distress Syndrome? Signs and symptoms of respiratory distress syndrome (RDS) usually occur at birth or within the first few hours that follow. They include: Rapid, shallow breathing Sharp pulling in of the chest below and between the ribs with each breath Grunting sounds Flaring of the nostrils The infant also may stop breathing for a few seconds every now and then. This condition is called apnea. . It also can cause mental retardation or cerebral palsy.

What Are the Signs and Symptoms of ARDS?

The major signs and symptoms of acute respiratory distress syndrome (ARDS) are: Shortness of breath

 Fast, labored breathing A bluish skin color (due to a low level of oxygen in the blood) A lower amount of oxygen in the blood Doctors and other health care providers watch for these signs and symptoms in patients who have conditions that might lead to ARDS. People who develop ARDS may be too sick to complain about having trouble breathing or other related symptoms. If a patient shows signs of developing ARDS, doctors will do tests to confirm that ARDS is the problem. ARDS is often associated with the failure of other organs and body systems, including the liver, kidneys, and the immune system. Multiple organ failure often leads to death.

Exams and Tests for ARDS Arterial blood gas analysis reveals hypoxemia (reduced levels of oxygen in the blood). A complete blood count may be taken. The number of white blood cells is increased in sepsis. Chest x-ray will show the presence of fluid in the lungs. CT scan of the chest may be required only in some situations (routine chest x-ray is sufficient in most cases). Echocardiogram (an ultrasound of the heart) may help exclude any heart problems that can cause fluid buildup in the lung. Monitoring with a pulmonary artery catheter may be done to exclude a cardiac cause for the difficulty in breathing. Bronchoscopy (a procedure used to look inside the windpipe and large airways of the lung) may be considered to evaluate the possibility of lung infection.

ARDS Treatment Medical Treatment for ARDS Persons with ARDS are hospitalized and require treatment in an intensive care unit. No specific therapy for ARDS exists. Treatment is primarily supportive using a mechanical respirator and supplemental oxygen. Intravenous fluids are given to provide nutrition and prevent dehydration, and are carefully monitored to prevent fluid from accumulating in the lungs (pulmonary edema). Because infection is often the underlying cause of ARDS, appropriate antibiotic therapy is administered. Corticosteroids may sometimes be administered in ARDS or if the patient is in shock, but their use is controversial.

Medications for ARDS The following drugs may be administered: Antibiotics to treat infection

 Anti-inflammatory drugs, such as corticosteroids, to reduce inflammation in the lungs in the late phase of ARDS or sometimes if the person is in septic shock Diuretics to eliminate fluid from the lungs Drugs to counteract low blood pressure that may be caused by shock Anti-anxiety drugs to relieve anxiety Inhaled drugs administered by respiratory therapists to open up the airways (bronchodilators)

The term respiratory failure, in medicine, is used to describe inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia. The normal reference values are: oxygen PaO2 greater than 80 mmHg (11 kPa), and carbon dioxide PaCO2 less than 45 mmHg (6.0 kPa). Classification into type I or type II relates to the absence or presence of hypercapnia respectively.

Type 1 Type 1 respiratory failure is defined as hypoxemia without hypercapnia, and indeed the PaCO2 may be normal or low. It is typically caused by a ventilation/perfusion (V/Q) mismatch; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs. The basic defect in type 1 respiratory failure is failure of oxygenation characterized by: P a O2 PaCO2 PA-aO2 low (< 60 mmHg (8.0 kPa)) normal or low increased

This type of respiratory failure is caused by conditions that affect oxygenation such as: Parenchymal disease (V/Q mismatch) Diseases of vasculature and shunts: right-to-left shunt, pulmonary embolism interstitial lung diseases: ARDS, pneumonia, emphysema. [edit] Type 2 The basic defect in type 2 respiratory failure is characterized by: P a O2 PaCO2 PA-aO2 pH decreased increased normal decreased

Type 2 respiratory failure is caused by increased airway resistance; both oxygen and carbon dioxide are affected. Defined as the build up of carbon dioxide levels (PaCO2) that has been generated by the body. The underlying

causes include: Reduced breathing effort (in the fatigued patient) A decrease in the area of the lung available for gas exchange (such as in emphysema). [edit] Causes Chest X-ray showing ARDS Pulmonary dysfunction Asthma Emphysema Chronic Obstructive Pulmonary Disease Pneumonia Pneumothorax Pulmonary contusion[1] Hemothorax Acute Respiratory Distress Syndrome (ARDS) is a specific and life-threatening type of respiratory failure. Cystic Fibrosis Cardiac dysfunction Pulmonary edema Cerebrovascular Accident Arrhythmia Congestive heart failure Valve pathology Other Fatigue due to prolonged tachypnoea in metabolic acidosis Intoxication with drugs (e.g., morphine, benzodiazepines) that suppress respiration. Neurological Disease Toxic Epidermal Necrolysis [edit] Treatment Mechanical Ventilator Emergency treatment follows the principles of cardiopulmonary resuscitation. Treatment of the underlying cause is required. Endotracheal intubation and mechanical ventilation may be required. Respiratory stimulants such as doxapram may be used, and if the respiratory failure resulted from an overdose of sedative drugs such as opioids or benzodiazepines, then the appropriate antidote such as naloxone or flumazenil will be given.