title: The impact of parenteral narcotic choice in the development of acute chest syndrome in sickle cell disease.
abstract: BACKGROUND
  Acute chest syndrome (ACS) represents a serious morbidity and often fatal complication in patients with sickle cell disease. Painful episodes which require hospitalization are most often treated with opioids, which may then influence the development of ACS. Nalbuphine is a parenteral opioid which effectively treats pain and may cause less ACS.
  
  
  METHODS
  This retrospective chart review documented 988 admissions for painful episodes at 2 institutions and recorded the incidence of ACS and opioid used.
  
  
  RESULTS
  At the Children's Hospital in St Louis, Missouri, the incidence of ACS in patients treated with morphine alone was 10.8% versus at the Children's Mercy Hospital in Kansas City, Missouri, the incidence was 2.1% for patients treated solely with nalbuphine.
  
  
  CONCLUSIONS
  When nalbuphine is used alone as the single parenteral opioid agent to treat painful episodes in patients with sickle cell disease, the incidence of ACS is less than when compared with other opioids used to treat pain.
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO 64108, USA. klewing@cmh.edu
authors.forename: Karen
authors.initials: K
authors.lastname: Lewing
authors.forename: Kristen
authors.initials: K
authors.lastname: Britton
authors.forename: Michael
authors.initials: M
authors.lastname: DeBaun
authors.forename: Gerald
authors.initials: G
authors.lastname: Woods
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000453:epidemiology*; D002637:Chest Pain / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009017:Morbidity; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D009266:Nalbuphine / Q000008:administration & dosage / Q000009:adverse effects*; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D010290:Parents; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D009294:Narcotics; D009020:Morphine; D009266:Nalbuphine