Dr. Glick correctly points out that none of the findings in case 11 are specific for Reye syndrome. As with many syndromes the diagnosis must be based on a combination of findings. The strength of Dr. Glick's statement about clinical findings and hypoglycemia leads me to suspect that he has applied his experience with similar patients in the United States to the evaluation of their significance in this case. At Khon Kaen Hospital, during the season this case was seen, Reye syndrome accounted for more than one half of all cases of acute encephalopathy (seizures, coma, or the combination) and more than one half of all pediatric deaths. In the course of studying acute encephalopathy in Northeast Thailand, SEATO laboratory investigators have studied 104 other patients with hypoglycemia.2,3 In 101 the final diagnosis was Reye syndrome. Given nothing but the two hoof beats, acute encephalopathy and hypoglycemia, Reye
Glasgow AM. Lean Reye Syndrome-Reply. Am J Dis Child. 1973;125(6):901–902. doi:10.1001/archpedi.1973.04160060097026
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