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Hepatic encephalopathy (HE) is an important and common metabolic disturbance in children. The causes are many. Reye-like syndrome (RLS) can manifest with hypoglycemia, hyperammonemia and altered sensorium with elevated liver enzymes as in Reye syndrome, where the cause remains elusive. This disease is associated with a significant risk of mortality. This report discusses the diagnostic possibilities with a brief review of literature in a one year boy who recovered completely from acute hepatic encephalopathy.