Sir.—We read with considerable interest the article by Lovejoy et al that appeared in the July issue of the Journal (128:36, 1974). We have recently seen eight patients with Reye syndrome at Stanford University Hospital and our experience has been quite different from that reported. We will describe a patient who survived stage V with minor sequelae, and report our incidence of hypoglycemia and hypoglycorrhachia, and our experience with the predictive value of serum ammonia levels.
All of our patients would have met the four criteria used to determine admission to the Children's Hospital study. Their ages ranged from 10 months to 14 years. A preceding viral illness, hyperventilation, and vomiting were seen in every patient. Three developed papilledema; five had seizures. One patient remained in stage I, one progressed to stage II, and three progressed to stage III. Three patients progressed to stage V; one of these, described