Ketorolac-induced irreversible renal failure in sickle cell disease: a case report.
Nonsteroidal anti-inflammatory drugs are often used in the management of those with acute pain secondary to sickle cell disease due to potent analgesic effects along with a lack of addictive potential, respiratory depression, and central nervous system effects, as may occur with narcotics. Caution should be observed in the use of nonsteroidal anti-inflammatory drugs in patients with compromised renal function. We present a case of a 17-year-old sickle cell disease patient with an acute painful episode and normal renal function indices who subsequently developed irreversible renal failure and a perirenal hematoma following the administration of ketorolac, despite adequate hydration. Due to its inhibitory effect on prostaglandin-mediated vasodilation, we advise caution in the use of ketorolac for the pain management of sickle cell painful episodes. We recommend following the administration guidelines for ketorolac for renal-compromised patients in those with painful episodes of sickle cell disease, and if used in this patient population, renal function must be very closely monitored.
Simckes
A M
AM
Section of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Chen
S S
SS
Osorio
A V
AV
Garola
R E
RE
Woods
G M
GM
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020910:Ketorolac; D051437:Renal Insufficiency / Q000139:chemically induced*; D014046:Tolmetin / Q000009:adverse effects / Q000031:analogs & derivatives*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D014046:Tolmetin; D020910:Ketorolac