Snap Shot A 10 year-old child has skin papules that began 5 days ago and was given aspirin for fever. She now presents with vomiting and lethargy. PE shows mild hepatomegaly. Total bilrubin, and serum ammonium are increased. Introduction Acute encephalopathy and liver degeneration associated with ingesting aspirin during a a flu-like illness or varicella Usually 4-12 years of age Presentation Symptoms biphasic course with prodromal fever, asymptomatic interval, followed by abrupt onset of vomiting delirium stupor hepatomegaly symptoms of increasing ICP Evaluation Liver enzymes and ammonia are elevated Liver biopsy typically shows fatty vacuolization of hepatocytes Treatment Treatment consists of controlling ICP (major cause of death) mannitol fluid restriction Prognosis, Prevention, and Complications Rapid recovery in mild disease Severe disease may leads to neuropsychological defects