Lactated Ringer solution superior to normal saline for sickle cell vaso-occlusive episodes
Click Here to Manage Email Alerts
Key takeaways:
- Lactated Ringer solution is the preferred volume resuscitation fluid for patients with sickle cell disease who experience vaso-occlusive episodes.
- Resuscitation with normal saline can promote erythrocyte sickling.
IV lactated Ringer solution should be the preferred volume-expanding fluid for resuscitation of patients with sickle cell disease who experience vaso-occlusive episodes at the time of hospital admission, according to study results.
Patients who received lactated Ringer experienced fewer days in the hospital compared with those who received normal saline, according to researchers.
“Although the most patients received normal saline, we found that those who received lactated Ringer had small but significant improvements in outcomes, including hospital-free days and rates of readmission,” Augusta K. Alwang, MD, resident physician at Boston Medical Center and clinical instructor trainee of the general internal medicine addiction medicine program at Boston University, and colleagues wrote. “We hypothesize that these observed results could be unique to patients with sickle cell disease and are possibly related to detrimental effects of unbalanced fluid increasing erythrocyte sickling.”
People with sickle cell disease experience vaso-occlusive episodes that can require hospitalization; however, resuscitation with normal saline to improve concurrent hypovolemia can promote erythrocyte sickling.
Alwang and colleagues conducted a multicenter cohort study and target trial emulation to compare the effectiveness of lactated Ringer to normal saline fluid resuscitation for patients with sickle cell disease who experience vaso-occlusive episodes.
They used the Premier PINC AI database — which encompasses about one-quarter of U.S. hospitalizations — to identify 55,574 adult encounters (median age, 30 years; interquartile range, 25-37) between Oct. 6, 2023, and June 20, 2024.
The majority (93.7%; n = 52,079) received normal saline on day 1 of their hospital stay, whereas 6.3% (n = 3,495) received lactated Ringer.
Hospital-free days by day 30 served as the primary outcome.
Patients who received lactated Ringer experienced more hospital-free days when than those who received normal saline (marginal mean difference = 0.4 days; 95% CI, 0.1-0.6).
Patients who received lactated Ringer also had shorter hospital lengths of stay (marginal mean difference = 0.4; 95% CI, 0.7 to 0.1) and lower risk for 30-day readmission (marginal mean difference = 5.8%; 95% CI, 9.8% to 1.8%).
The difference in hospital-free days between the two methods varied based on fluid volume received. They noted no difference among patients who received less than 2 L; however, among those who received 2 L or more, lactated Ringer appeared superior to normal saline.
“[The study] should be heralded because it is an apt use of existing population-level observational data from an administrative database to support the clinical research of a well-defined and highly relevant clinical question in an understudied population,” A. Parker Ruhl, MD, associate director for clinical faculty affairs in NIH’s Office of Intramural Research, and colleagues wrote. “Its findings direct us to redouble our scientific efforts to better elucidate the underlying mechanisms and pathophysiology of erythrocyte sickling and endothelial adhesion and how they interact to affect vaso-occlusion and vascular function.”
References:
Collapse
Click Here to Manage Email Alerts