From the Research
Ringer's Lactate (RL) is the preferred initial IV fluid for a patient with sickle cell disease presenting with chest pain, as it has been shown to have a small but significant improvement in hospital-free days and secondary outcomes compared to Normal Saline (NS) 1. The recommended approach is to start with RL, as it has been found to be superior to NS in patients who receive 2 or more liters of fluid, with a marginal mean difference of 0.4 hospital-free days and a lower risk of 30-day readmission 1. Some studies have suggested that NS may be associated with increased sickle red cell stiffness and prolonged transit times in a microfluidic model of the capillary system 2, but the most recent and highest quality study suggests that RL is the preferred choice 1. Key considerations when administering IV fluids to patients with sickle cell disease include:
- Monitoring for fluid overload, especially in patients with cardiac or renal compromise
- Providing adequate pain management concurrently with fluid resuscitation
- Avoiding dehydration, which is a common trigger for sickling
- Improving blood flow through the microvasculature to help resolve the vaso-occlusive crisis that may be causing the chest pain. It is also important to note that the goal of fluid therapy is to improve hydration status, reduce blood viscosity, and help resolve the vaso-occlusive crisis that may be causing the chest pain, and that RL has been shown to be effective in achieving these goals 1.