DrVirgo
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ASA is contraindicated in viral infections in peds. due to Reye's Syndrome.
(Is it only in viral illnesses or other times as well?)...
ASA is OK for Kawasaki, and is the treatment of choice....
So, I'm asking when is it OK to give ASA, and when is it contraindicated in children?
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| cirus
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ASA is contraindicated in anything else other than Kawasaki (monitor LFTs) before the age of 15yrs
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| Justice
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ASA is also given in Juvenile form of RA (AKA Still's syndrome or Chauffard-Ramon-Still disease)...
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| neuroblastoma
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Intravenous gamma globulin (IVIGG) is the standard treatment for Kawasaki disease and is administered in high doses with marked improvement usually noted within 24 hours.
Salicylate therapy, particularly aspirin, remains an important part of the treatment but salicylates alone are not as effective as IV gamma globulin. Aspirin therapy is started at high doses until the fever subsides, and then is continued at a low dose when the patient returns home. Except for Kawasaki disease and a couple of other indications, aspirin is otherwise normally not recommended for children due to its association with Reye's syndrome.
Corticosteroids have also been used, especially when other treatments fail or symptoms recur, but in a randomized controlled trial, the addition of corticosteroid to immune globulin and aspirin did not improve outcome.
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| neuroblastoma
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KAWASAKI DISEASE often begins with a high and persistent fever that is not very responsive to normal doses of acetaminophen or ibuprofen. The fever may persist steadily for up to two weeks and is normally accompanied by irritability. Affected children develop red eyes, red mucous membranes in the mouth, red cracked lips, a "strawberry tongue", iritis, keratic precipitates (detectable by an ophthalmologist but usually too small to be seen by the unaided eye), and swollen lymph nodes. Skin rashes occur early in the disease, and peeling of the skin in the genital area, hands, and feet (especially around the nails and on the palms and soles) may occur in later phases.
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| DrVirgo
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Salicylates in children ONLY for:
1. Kawasaki
2. JRA
3. Ulcerative Colitis (aminosalicylates)
Any others ???
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| DrVirgo
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Does everyone agree?
Does Reyes ONLY happen when we have BOTH a viral infection AND use of ASA, or can it occur with ASA alone?
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| GOGETA
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DrVirgo wrote:
Does everyone agree?
Does Reyes ONLY happen when we have BOTH a viral infection AND use of ASA, or can it occur with ASA alone?
with the viral infection for what I understand
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| hero
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fever-causing illness + ASA
Also
The vast majority of children who take aspirin while ill with a virus such as chicken pox or flu do not develop Reye's syndrome
and
some children who are diagnosed with the syndrome may not have taken aspirin or salicylates.
http://en.wikipedia.org/wiki/Reye's_syndrome
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| cuadrado_g
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good posts. but i am not sure if we are in the fields of step 1 rather than 3? talking about etiology?? Let me put my thoughts:
1. Reye classically is the combinations of Viral Ilness (Influenza and Varicella Zoster ) with ASA usage. Exceptions can be found as hero wrote.
2. ASA for children is given in: 1. Kawasaki 2. JRA (Still Dz) 3. Henoch Scheloin Purpura. Didnt kwon about 4. UC and aminosalycilates usage Dr Virgo, not sure. UC is a inflamation of the distal colon and the treatment should be supositories and so local mesalamine; and it would not have the risk of going systemic and cause Reye?...Maybe if its Chrons it would apply?...Please correct me anybody of I am wrong
ANyways, I think thats maybe low yield. Ive seen questions asking about influenza vaccination in children with chronic ASA treatment with Kawasaki and JRA
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| DrVirgo
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Thanks for the input cuadrado...
About the Peds UC treatment and aminosalycilates, I read that in Kap-Peds.
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| cuadrado_g
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Correction to my last post
For JRA and HSP, another NSAID other than ASA are indicated; if u want more specific Indomethacin for JRA and Naproxen for HSP. The only association with Reyes is ASA so in the other cases, Influenza vaccination is not indicated
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| inkspot
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influenza virus and not vaccine is a possible association
chicken pox
and ASA use.
ASA indications are mentioned above. In kawasaki coz of thrombosis and coronary aneurysm. there is increased risk of MI ( yes MI in a 4 year )
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