Effect of Intravenous Fluid Therapy in Managing Acute Painful Crises in Sickle Cell Disease Patients

Abstract

Background: Sickle cell disease (SCD), an autosomal recessive mutation leading to alterations in the shape of red blood cells, compromises their oxygen-carrying capacity, and is prevalent in Saudi Arabia. Individuals with SCD experience vaso-occlusive crises, leading to severe pain episodes. Although fluid administration is a common practice to deter the sickling process, limited data exist on its efficacy. Method: This substudy was preplanned within the published randomized control trial titled \"Ketamine Administration for Acute Painful Sickle Cell Crisis: A Randomized Controlled Trial,\" conducted at King Fahad University Hospital in Saudi Arabia in 2019. Results: The analysis included 139 patients. Both arms received equal amounts and types of analgesics, with 51.7% receiving up to 500 ml intravenous fluid and 48.3% receiving more than 500 ml. Of the participants, 23.7% were admitted to the hospital, while 76.3% were discharged. The average length of stay in the emergency department (ED) was 4.6 ± 2.1 hours. There was no significant difference in the average pain score between the arms at 30-120 minutes. However, patients who received more fluid (> 500 ml) exhibited a higher admission rate and a longer ED stay. Conclusions: The amount of fluid administered to SCD patients in the emergency department during a vaso-occlusive crisis did not show a significant difference in pain score improvement. Notably, patients receiving more fluid demonstrated longer ED stays and higher admission rates.