Pulmonary edema. Complication in the management of sickle cell pain crisis.
Over a 12-month period, there were 51 admissions for sickle cell pain crisis. Of these, the course of four patients (two with hemoglobin SS, one with hemoglobin SC, and one with hemoglobin S-Thal) was complicated by the development of pulmonary edema. Pulmonary edema complicating the management of sickle cell pain crisis has not previously been described. Vigorous fluid replacement with hypotonic saline and parenteral narcotic analgesics are conventional modalities of therapy, but may contribute to the development of pulmonary edema. Narcotic analgesics causing increased permeability are well established. In pulmonary vascular beds predisposed to injury, hypotonic saline administration causing an increased hydrostatic pressure and decreased oncotic pressure may further compound pulmonary edema development. On the basis of the experience in this study, a conservative approach to the use of fluid administration and narcotic analgesics is advised.
Haynes
J
J
Allison
R C
RC
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006450:Hemoglobin SC Disease / Q000150:complications / Q000628:therapy; D006801:Humans; D007038:Hypotonic Solutions; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011859:Radiography; D012965:Sodium Chloride / Q000009:adverse effects; D013789:Thalassemia / Q000150:complications / Q000628:therapy
D000701:Analgesics, Opioid; D007038:Hypotonic Solutions; D012965:Sodium Chloride