From the Guidelines
For hydration in sickle cell patients, 0.9% normal saline (0.9% sodium chloride solution) is generally preferred over 0.5% saline. When managing sickle cell patients during vaso-occlusive crises or for routine hydration, normal saline should be administered intravenously at 1.5 times maintenance rates. For an adult, this typically means infusing at rates of 125-150 mL/hour, adjusting based on the patient's weight and clinical status. The higher concentration of 0.9% saline is preferred because it provides better intravascular volume expansion, which is crucial for improving blood flow and reducing blood viscosity in sickle cell disease. Adequate hydration helps prevent sickling of red blood cells by diluting the blood and reducing the concentration of sickled cells. Additionally, normal saline helps correct any metabolic acidosis that may be present during a crisis, which can further trigger sickling. According to a systematic review and clinical recommendations published in the American Journal of Hematology in 2020 1, intravenous hydration is recommended by most authors until oral intake is fully re-established, and the use of hypertonic fluids for hydration is strongly discouraged due to its potential for further dehydration of sickle cells.
Some key points to consider when administering saline to sickle cell patients include:
- Monitoring for signs of fluid overload, especially in patients with cardiac or renal compromise
- Adjusting the infusion rate based on the patient's weight and clinical status
- Avoiding the use of hypertonic fluids, which can exacerbate dehydration of sickle cells
- Considering the use of other supportive measures, such as pain management and oxygen therapy, as needed
It's also important to note that the specific indications for saline administration in sickle cell patients may vary depending on the individual patient's needs and clinical status. However, in general, 0.9% normal saline is the preferred choice for hydration in sickle cell patients due to its ability to provide effective intravascular volume expansion and help prevent sickling of red blood cells 1.
From the Research
Saline Concentration for Sickle Cell Patients
- The preferred saline concentration for hydration in sickle cell patients is not explicitly stated in the provided studies as .5 saline vs .9 saline.
- However, a study published in 2024 2 compared the effectiveness of lactated Ringer (LR) to normal saline (NS) fluid resuscitation in patients with sickle cell disease and vaso-occlusive episodes.
- The study found that patients who received LR had more hospital-free days, shorter hospital lengths of stay, and lower risk of 30-day readmission compared to those who received NS.
Indications for Saline Concentration
- The choice of saline concentration may depend on the individual patient's needs and the specific clinical scenario.
- A study published in 2012 3 noted that extra fluids are routinely given as adjunct treatment for vaso-occlusive painful crises in people with sickle cell disease, regardless of the individual's state of hydration.
- However, the study also highlighted the need for a multicentre randomised controlled trial to assess the efficacy and possible adverse effects of different routes, types, and quantities of fluid administered to people with sickle cell disease during acute painful episodes.
Current Guidelines and Recommendations
- A 2014 evidence-based report by expert panel members 4 provided strong recommendations for the management of sickle cell disease, including the use of hydroxyurea and long-term blood transfusions.
- The report also emphasized the importance of preventive services, such as daily oral prophylactic penicillin and annual transcranial Doppler examinations.
- A 2020 literature review 5 suggested that current rationales for hydration and nutritional strategies for sickle cell patients during periods of crisis are generally based on consensus and have remained largely undefined to date.
- A 2023 overview of sickle cell disease 6 highlighted the importance of understanding the causes, symptoms, and treatment options for the condition, including pain management with analgesics, hydration, and blood transfusions.